Abstract
BackgroundThe Global Plan to Stop TB estimates funding required in low- and middle-income countries to achieve TB control targets set by the Stop TB Partnership within the context of the Millennium Development Goals. We estimate the contribution and impact of Global Fund investments under various scenarios of allocations across interventions and regions.Methodology/Principal FindingsUsing Global Plan assumptions on expected cases and mortality, we estimate treatment costs and mortality impact for diagnosis and treatment for drug-sensitive and multidrug-resistant TB (MDR-TB), including antiretroviral treatment (ART) during DOTS for HIV-co-infected patients, for four country groups, overall and for the Global Fund investments. In 2015, China and India account for 24% of funding need, Eastern Europe and Central Asia (EECA) for 33%, sub-Saharan Africa (SSA) for 20%, and other low- and middle-income countries for 24%. Scale-up of MDR-TB treatment, especially in EECA, drives an increasing global TB funding need – an essential investment to contain the mortality burden associated with MDR-TB and future disease costs. Funding needs rise fastest in SSA, reflecting increasing coverage need of improved TB/HIV management, which saves most lives per dollar spent in the short term. The Global Fund is expected to finance 8–12% of Global Plan implementation costs annually. Lives saved through Global Fund TB support within the available funding envelope could increase 37% if allocations shifted from current regional demand patterns to a prioritized scale-up of improved TB/HIV treatment and secondly DOTS, both mainly in Africa − with EECA region, which has disproportionately high per-patient costs, funded from alternative resources.Conclusions/SignificanceThese findings, alongside country funding gaps, domestic funding and implementation capacity and equity considerations, should inform strategies and policies for international donors, national governments and disease control programs to implement a more optimal investment approach focusing on highest-impact populations and interventions.
Highlights
The Global Plan to Stop TB for 2011 to 2015 (Global Plan), developed by the Stop TB Partnership with major inputs from the World Health Organization (WHO), sets out the level of tuberculosis (TB) interventions and funding that National TB Control Programs (NTPs) will need to reach Millennium Development Goal (MDG) 6 TB targets and the related targets set by the Stop TB Partnership for 2015
Projections assume that Global Plan targets and funding requirements are fully met, that all TB cases detected by NTPs are first treated for drug-susceptible TB, and that a sub-set of these subsequently get tested and treated for multi-drugresistant TB (MDR-TB) or receive antiretroviral treatment (ART) if co-infected with HIV
Service Coverage and Funding Needs Overall Global Plan targets for low- and middle-income countries (LMIC) in 2015 [1] are 6.9 million DOTS treatments for drug-susceptible TB, including 1.0 million people living with HIV, and 0.27 million multi-drug resistant (MDR)-TB
Summary
The Global Plan to Stop TB for 2011 to 2015 (Global Plan), developed by the Stop TB Partnership with major inputs from the World Health Organization (WHO), sets out the level of tuberculosis (TB) interventions and funding that National TB Control Programs (NTPs) will need to reach Millennium Development Goal (MDG) 6 TB targets and the related targets set by the Stop TB Partnership for 2015 (see section). The Plan’s cost projections are based on estimates of TB disease and deaths, intervention targets and service implementation costs for low- and middle-income countries (LMIC) [1]. Between its launch in 2002 and the end of 2011, the Global Fund invested US$2.3 billion in TB grants in 116 countries, and disbursed in 2010 US$512 million in TB grants [4]. In 2010, the Global Fund estimated donor pledges and projected income of US$11.7 billion for investment in HIV, TB and malaria over 2011 to 2013 [5]. The Global Plan to Stop TB estimates funding required in low- and middle-income countries to achieve TB control targets set by the Stop TB Partnership within the context of the Millennium Development Goals. We estimate the contribution and impact of Global Fund investments under various scenarios of allocations across interventions and regions
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