Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
PLoS One. 2012;7(6):e38816. doi: 10.1371/journal.pone.0038816. Epub 2012 Jun 18.
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.
METHODOLOGY/PRINCIPAL FINDINGS: Using 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/SIGNIFICANCE: These 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.
全球结核病规划估计了在中低收入国家实现结核病控制目标所需的资金，这些目标是在千年发展目标框架内由遏制结核病伙伴关系制定的。我们估计了在各种分配方案下，全球基金投资对各干预措施和地区的贡献和影响。
方法/主要发现：利用全球计划对预期病例和死亡率的假设，我们估计了针对药物敏感和耐多药结核病（MDR-TB）的诊断和治疗的治疗费用和死亡率影响，包括 HIV 合并感染患者在 DOTS 期间的抗逆转录病毒治疗（ART），针对四个国家组、总体和全球基金投资进行了估计。2015 年，中国和印度占资金需求的 24%，东欧和中亚（EECA）占 33%，撒哈拉以南非洲（SSA）占 20%，其他中低收入国家占 24%。MDR-TB 治疗的扩大，特别是在 EECA，推动了全球结核病资金需求的增加——这是遏制与 MDR-TB 相关的死亡率负担和未来疾病成本的必要投资。在 SSA，资金需求增长最快，反映出改善结核病/艾滋病管理的覆盖范围需求增加，这在短期内每花费一美元就能拯救最多的生命。预计全球基金每年将为全球计划实施费用提供 8-12%的资金。如果将资源从当前的区域需求模式重新分配到优先扩大改进的结核病/艾滋病治疗和其次是 DOTS，那么在现有的资金范围内，全球基金结核病支持所挽救的生命将增加 37%，主要在非洲——EECA 地区的人均费用过高，将由其他资源提供资金。
结论/意义：这些发现，以及国家资金缺口、国内资金和实施能力以及公平性考虑，应该为国际捐助者、国家政府和疾病控制规划提供信息，以制定更优化的投资策略，重点关注受影响最大的人群和干预措施。
