Access to novel anti-diabetic agents in resource limited settings:A brief commentary

The prevalence of diabetes mellitus is increasing in resource limited settings.Simultaneously,there has been an increase in the number of novel therapies for the management of diabetes mellitus.However,use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings.Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes,and thus most likely to benefit from the therapy,are less likely to have negative budget impact for funders.To improve access,and reduce morbidity and mortality,requires alignment amongst key stakeholders including patient advocacy groups,health care professional councils,national departments of health,the pharmaceutical industry,treasury and finance departments.

Exclusive Fibula Osteosynthesis for Treating Open Fractures Gustillo I-III B of the Distal Half of the Leg Bones in a Resources-Limited Setting

Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.

Challenges in initiating antiretroviral therapy for all HIV-infected people regardless of CD4 cell count

Introduction:Recently published large randomized controlled trials,START,TEMPRANO and HPTN 052 show the clinical benefit of early initiation of antiretroviral treatment(ART)in HIV-infected persons and in reducing HIV transmission.The trials influenced the World Health Organization(WHO)decision to issue updated recommendations to prescribe ART to all individuals living with HIV,irrespective of age and CD4 cell count.Discussion:It is clear that the new 2015 WHO recommendations if followed,will change the face of the HIV epidemic and probably curb its burden over time.Implementation however,requires that health systems,especially those in low and middle-income settings,be ready to face this challenge on a large scale.HIV prevention and treatment are easy in theory yet hard in practice.The new WHO guidelines for initiation of ART regardless of CD4 cell count will lead to upfront increases in the costs of healthcare delivery as the goal is to treat all those now newly eligible for ART.Around 22 million people living with HIV qualify and will therefore require ART.Related challenges immediately follow:firstly,that everyone must be tested for HIV;secondly,that anyone who has had an HIV test should know their result and understand its significance;and,thirdly,that every person identified as HIV-positive should receive and remain on ART.The emergence of HIV drug resistant strains when treatment is started at higher CD4 cell count thresholds is a further concern as persons on HIV treatment for longer periods of time are at increased risk of intermittent medication adherence.Conclusions:The new WHO recommendations for ART are welcome,but lacking as they fail to consider meaningful solutions to the challenges inherent to implementation.They fail to incorporate actual strategies on how to disseminate and adopt these far-reaching guidelines,especially in sub-Saharan Africa,an area with weak healthcare infrastructures.Well-designed,high-quality research is needed to assess the feasibility,safety,acceptability,impact,and cost of innovations such as the universal voluntary testing and immediate treatment approaches,and broad consultation must address community,human rights,ethical,and political concerns.