title: One size fits all? Standardised provision of care for survivors of sexual violence in conflict and post-conflict areas in the Democratic Republic of Congo.
abstract: BACKGROUND
  Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
  
  
  METHODS
  A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
  
  
  RESULTS
  In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13-17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20-35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
  
  
  CONCLUSIONS
  This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Jerlie
authors.initials: J
authors.lastname: Loko Roka
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.
authors.forename: Sokhieng
authors.initials: S
authors.lastname: Au
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Brussels, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: De Plecker
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.
authors.forename: Marcel
authors.initials: M
authors.lastname: Manzi
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operations Department, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lambert
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Elias
authors.initials: E
authors.lastname: Abi-Aad
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Kassi
authors.initials: K
authors.lastname: Nanan-N'Zeth
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Serge
authors.initials: S
authors.lastname: Nzuya
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Omba
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Charly
authors.initials: C
authors.lastname: Shako
authors.affiliation: Ministère de la Santé, Bureau Central Zone de Santé Masisi, Masisi, Democratic Republic of Congo.
authors.forename: Derick
authors.initials: D
authors.lastname: MuishaBaroki
authors.affiliation: Ministère de la Santé, Bureau Central Zone de Santé Masisi, Masisi, Democratic Republic of Congo.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Basimuoneye
authors.affiliation: Ministère de la Santé, Bureau Central Zone de Santé Niangara, Niangara, Democratic Republic of Congo.
authors.forename: Didier Amudiandroy
authors.initials: DA
authors.lastname: Moke
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lampaert
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Lucien
authors.initials: L
authors.lastname: Masangu
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, DRC Mission, Kinshasa, Democratic Republic of Congo.
authors.forename: Anja
authors.initials: A
authors.lastname: De Weggheleire
mesh_terms: D000293:Adolescent; D000328:Adult; D015023:Democratic Republic of the Congo / Q000208:ethnology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012742:Sex Offenses / Q000208:ethnology* / Q000517:prevention & control*; D017741:Survivors; D014857:Warfare