Introduction of HIV post-exposure prophylaxis for sexually abused children in Malawi

Area of Science:

• Public Health
• Pediatrics
• Infectious Diseases

Background:

• Child sexual abuse (CSA) is a critical public health issue requiring prompt medical intervention.
• HIV post-exposure prophylaxis (PEP) is crucial for preventing HIV transmission after potential exposure.
• Resource-limited settings face unique challenges in managing CSA and HIV prevention.

Purpose of the Study:

• To assess the feasibility, safety, and efficacy of routinely offering HIV PEP to child sexual abuse victims.
• To improve the care pathway for children experiencing CSA in a resource-poor environment.
• To investigate the implementation of HIV PEP initiated in a pediatric emergency department.

Main Methods:

• Prospective study of children presenting with alleged CSA at Queen Elizabeth Central Hospital, Malawi.
• Eligibility for HIV PEP was assessed, and patients were followed for six months.
• Data collected on PEP provision, adherence, safety, and HIV seroconversion.

Main Results:

• 64 children presented with alleged CSA; 17 were offered and commenced HIV PEP.
• Reasons for not offering PEP included delayed presentation, absence of abuse signs, and existing HIV infection.
• No reported side effects from antiretroviral therapy; no seroconversions observed among those on PEP.
• Follow-up rates varied, with 11/17 returning at one month and 2/15 at six months.

Conclusions:

• HIV PEP following CSA is acceptable, safe, and feasible in resource-poor settings with high HIV prevalence.
• Integrating HIV PEP into national guidelines is recommended for countries with high community HIV prevalence.
• Pediatric emergency departments can effectively initiate and manage HIV PEP for CSA survivors.