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Korir G.K.,University of Massachusetts Lowell | Wambani J.S.,Kenyatta National Hospital | Korir I.K.,National Nuclear Regulator
Radiation Protection Dosimetry | Year: 2012

Assessment of patient dose attributed to multislice computed tomography (CT) examination. A questionnaire method was developed and used in recording the patient dose and scanning parameters for the head, chest, abdomen and lumbar spine examinations. The patient doses due to brain, chest and abdomen examination were above the international diagnostic reference levels (DRLs) by factors of between one and four. The study demonstrated that the use of multislice CT elevates patient radiation dose, justifying the need for local optimised scanning protocols and the use of institutional DRL for dose management without affecting diagnostic image quality. © The Author 2012. Published by Oxford University Press. All rights reserved. Source

Osoti A.O.,AIC | John-Stewart G.,University of Washington | Kiarie J.,University of Nairobi | Richardson B.,University of Washington | And 3 more authors.
AIDS | Year: 2014

Background: HIV testing male partners of pregnant women may decrease HIV transmission towomen and promote uptake of prevention ofmother-to-child HIVtransmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) clinics. We hypothesized that home visits to offer HIV testing to partners of women attending ANC would increase partner HIV testing. Methods: Women attending their first ANC were enrolled, interviewed using smartphone audio-computer-assisted self-interviews and randomized to home visits or written invitations for male partners to come to clinic, if they were married or cohabiting, unaccompanied by partners and had no prior couple HIVcounselling and testing (CHCT). Enrolled men were offered CHCT (HIV testing and mutual disclosure). Prevalence of CHCT, male HIV seropositivity, couple serodiscordance and intimate partner violence, reported as physical threat from partner, were compared at 6 weeks. Results: Among 495 women screened, 312 were eligible, and 300 randomized to clinic-based or home-based CHCT. Median age was 22 years (interquartile range 20-26 years), and 87%were monogamous. CHCT was significantly higher in home-visit than in clinic-invitation arm (n=128, 85% vs. n=54, 36%; P 0.001). Homearm identified more HIV-seropositive men (12.0 vs. 8.0%; P=0.248) and more HIVdiscordant couples (14.7 vs. 4.7%; P=0.003). There was no difference in intimate partner violence. Conclusion: Home visits of pregnant women were safe and resulted in more male partner testing and mutual disclosure of HIV status. This strategy could facilitate prevention of maternal HIV acquisition, improve PMTCT uptake and increase male HIV diagnosis. © 2013 Wolters Kluwer Health. Source

Heffron R.,University of Washington | Donnell D.,Fred Hutchinson Cancer Research Center | Rees H.,University of Witwatersrand | Celum C.,University of Washington | And 10 more authors.
The Lancet Infectious Diseases | Year: 2012

Background: Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners. Methods: In this prospective study, we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries. Among injectable and oral hormonal contraceptive users and non-users, we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men. The primary outcome measure was HIV-1 seroconversion. We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk. Findings: Among 1314 couples in which the HIV-1-seronegative partner was female (median follow-up 18·0 [IQR 12·6-24·2] months), rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not (adjusted hazard ratio 1·98, 95% CI 1·06-3·68, p=0·03). Among 2476 couples in which the HIV-1-seronegative partner was male (median follow-up 18·7 [IQR 12·8-24·2] months), rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception (adjusted hazard ratio 1·97, 95% CI 1·12-3·45, p=0·02). Marginal structural model analyses generated much the same results to the Cox proportional hazards regression. Interpretation: Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1. Funding: US National Institutes of Health and the Bill & Melinda Gates Foundation. © 2012 Elsevier Ltd. Source

Ekwom P.E.,Kenyatta National Hospital
East African medical journal | Year: 2010

Articular manifestations have been reported in HIV infection with a prevalence ranging from 2.5 to 68%. To determine the prevalence, types and characteristics of articular manifestations in the anti-retroviral treatment naive HIV infected patients. Cross sectional descriptive study. Comprehensive care clinic (HIV outpatient clinic) at the Kenyatta National Hospital (KNH) from October 2007 to March 2008. One hundread and ninety three patients; 135 females and 58 males, aged between 19 to 65 years with Human immunodeficiency virus (HIV) infection who were naive to anti - retroviral drug therapy. Presence of articular manifestations that included HIV associated arthritis, HIV associated spondyloarthropathies, HIV associated arthralgia, painful articular syndrome and avascular necrosis. Thirty three of these 193 patients had articular manifestation with a prevalence of 17.1%. The type prevalence was; HIV associated arthralgia, 15.6%; undifferentiated spondyloarthropathy, 1% and HIV associated arthritis; 0.5%. Their mean age was 36 +/- 9 years, range 23-63 years; majority were female, male to female ratio of 1: 2.3 and the majority were in World health organization (WHO) clinical staging of HIV infection, class II and III with a mean CD4 cell count of 330 cells/mm3. Seventeen (51.5%) of the patients with articular disease had oligo - articular presentation, 10(30.3%) mono - articular while 6(18.2%) had poly - articular presentation. The mean duration of joint pains was 53.3 days (range of 2-365 days). Six (18.2%) of these 33 patients missed work, home making activities or school due to the articular disease. Articular manifestations are common in HIV infection with a prevalence of 17.1%. HIV associated arthralgia was the most common manifestation. Majority of these patients were female, male to female ratio of 1: 2.3. The mean age of these patients was 36 years with a mean CD4 cell count of 330 cells/mm3 with 18.2% of them missing school or work. Source

Wambani J.S.,Kenyatta National Hospital
East African medical journal | Year: 2010

To assess the level of patient dose in Computed Tomography examination in Kenya, compare with the international diagnostic reference levels and establish the initial national diagnostic reference levels. The patient doses for brain, chest, abdomen and pelvis examinations were assessed using typical exposure factors on head and body dosimetry phantoms. A log normal graphical method was developed and used in deriving the initial national diagnostic reference levels for the two dose quantities. Twenty one representative Computed Tomography facilities at different hospitals and clinics. A questionnaire method was developed and used in recording the scanning parameters for head, chest, abdomen and pelvis adult examinations at each facility. The radiation exposure from Computed Tomography examinations was determined to be below the weighted Computed Tomography Dose Index (CTDIw) and Dose Length Product (DLP) reference levels by 90% and 62% respectively. The mean CTDIw measurements for the adult patients were below Diagnostic Reference levels (DRLs). The mean DLP values for adult patients in some examination were above DRLs, with large variations of up to a factor of eleven. This indicates the need for local optimised scanning protocols and use of local diagnostic reference level in order to reduce patient doses without affecting diagnostic image quality. Source

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