BackgroundWe examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya.MethodsWe analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method.ResultsMajority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %–6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV.ConclusionHealth facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.

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This article explores wound care nursing interventions and inter-professional collaboration for a patient referred with a stage 3 diabetic foot ulcer (DFU). To the patient’s distress, he had been informed that he may require an amputation due to the severity of his DFUs. On initial presentation, the patient was symptomatic for peripheral neuropathy, infection and hyperglycaemia. The left lower limb was oedematous and there was a DFU at the metatarso-phalangeal joint of the big toe on his left foot secondary to haemorrhagic callus. Progressive healing of the DFU was realised over time by repetitive debridement; incision and drainage of the DFUs; antibiotic therapy; appropriate footwear; dietary instructions; control of the blood sugar levels (BSLs); and patient and family education. Wound care nursing interventions were applied in conjunction with medical management of the DFUs. The DFUs were managed using a locally made, two-part zinc oxide gauze dressing known as the Unna boot. A family member was instructed how to continue applying the dressings at home in between clinic visits. Complete wound healing was eventually achieved within four months, thus avoiding the need for amputation.

Introduction: In order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital,