Indicative TB-related universal access and social protection indicators and targets.

<p>All indicators should be disaggregated by sex and age.</p>a<p>Should be disaggregated for drug-susceptible and drug-resistant TB.</p>b<p>These indicators should be disaggregated by age, sex, and socioeconomic status, or in the case of geographical coverage mapped against poverty mapping.</p><p>NTP, national tuberculosis programme; NA, not applicable.</p><p>Indicative TB-related universal access and social protection indicators and targets.</p

TB indicators mapped against the preferred attributes of intervention coverage indicators for general universal health coverage monitoring [49].

<p>TB indicators mapped against the preferred attributes of intervention coverage indicators for general universal health coverage monitoring <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001693#pmed.1001693-Huseynova1" target="_blank">[49]</a>.</p

The three dimensions of universal health coverage, with the added dimension of financial risk protection against non-medical costs.

<p>Adapted from World Health Report 2010 <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001693#pmed.1001693-WHO4" target="_blank">[21]</a>. Elements in red are non-medical costs and additional interventions within health care and beyond to provide financial protection.</p

Framework to illustrate the interrelationship between universal health coverage, social protection, TB outcomes, and public health and social impact.

<p>Framework to illustrate the interrelationship between universal health coverage, social protection, TB outcomes, and public health and social impact.</p

Assumed per-patient cost (US $) of projected TB interventions by country group.

<p>Notes: Stated amounts reflect unit costs in US$ as of 2010, of (i) diagnosing and treating one TB patient under DOTS <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-StopTB1" target="_blank">[1]</a> and (ii) the additional cost incurred if the patient has multi-drug resistant (MDR) TB as estimated in the WHO/Stop TB partnership Global Plan to Stop TB 2011–2015 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-StopTB1" target="_blank">[1]</a>, and (iii) the additional cost incurred if the patient is HIV-positive and receives antiretroviral therapy (ART) for the duration of a 6-month DOTS course <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-Stover1" target="_blank">[47]</a>. Costs are inflated at 3% per annum. Regional cost estimates were based on country cost estimates, weighted by each country’s notified incident cases.</p

Global Fund contribution to TB control, low- and middle-income countries.

<p>(A): Expected Global Fund TB expenditures; (B): Corresponding proportional share in the total funding need for DOTS, MDR-TB and TB/HIV treatment. Note to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone-0038816-g002" target="_blank">Figure 2:</a> Projections based on October 2010 donor pledges for 2011−2013.The projected decline after 2012 is larger for the Global Fund’s proportional contribution than for its absolute TB expenditures, as global TB funding needs continue to rise through 2015.</p

Cost components borne by NTPs, included in the Global Plan to Stop TB, 2011–2015.

<p>Notes: In addition to DOTS, management of MDR-TB and TB/HIV, the Global Plan includes estimates of costs for co-trimoxazole preventive therapy (CPT) during DOTS, nutritional support, HIV serological testing and counselling for HIV-coinfected patients, and isoniazid-based preventive therapy (IPT) to prevent HIV-positive people with latent <i>Mycobacterium tuberculosis</i> infection from developing active TB disease <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-StopTB1" target="_blank">[1]</a>. Our projections do not include these added costs, which are relatively small for CPT (e.g. less than $10 per patient-year in Uganda <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-Pitter1" target="_blank">[48]</a>), difficult to express per TB patient for IPT, which concerns HIV-infected patients <i>without</i> active TB, and not necessarily borne by NTPs for nutritional support and for HIV testing and counselling. Globally, uptake of IPT remains low, in spite of efforts by normative and financing agencies to increase its implementation <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-Zumla1" target="_blank">[49]</a>. One factor contributing to this slow uptake is the absence of sensitive and specific tests distinguishing between active disease and latent TB <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-Zumla1" target="_blank">[49]</a>; other factors warrant further exploration by the major normative and financing agencies for TB control.</p

Sources of funding for TB control, according to NTP preliminary 2010 budgets.

<p>Notes: Preliminary NTP budgets for 2010 were reported to WHO by 107 of the 149 Global Plan countries, which together accounted for 98% of the global burden of TB in 2009 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-World2" target="_blank">[9]</a>. According to these figures, $3.8 billion was available from domestic sources in 2010. This domestic contribution included approximately$1.5 billion spent on general inpatient and outpatient health services, outside of NTP budgets, which were estimated based on costs and frequencies of hospital admissions and outpatient visits to health facilities by TB patients <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-World2" target="_blank">[9]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-Floyd1" target="_blank">[20]</a>.</p><p>Government: national governments including loans; Grants: external donors excluding the Global Fund; Total available = general health services + Government + Global Fund + Other grants. Need: total TB control need, as defined in the 2010 Global Plan to Stop TB. Domestic = General health services + Government; GDP = gross domestic product (purchasing power parity); Regional share of Global Fund = proportion of worldwide Global Fund TB disbursements going to each region, average 2007 to 2009.</p

Percentage distribution of funding need for implementing DOTS, MDR-TB treatment and ART during DOTS, over regions in 2015.

<p>Notes: The projected total funding need for the three services in 2015 is US$7.9 billion according to the Global Plan to Stop TB 2011–2015 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038816#pone.0038816-StopTB1" target="_blank">[1]</a>. <i>DOTS</i> is the cost of first-line DOTS for all TB cases including those with MDR-TB and/or coinfected with HIV. <i>MDR</i> is the <i>additional</i> cost for treating those with MDR-TB and <i>ART</i> the <i>additional</i> cost for treating those that are HIV-positive with ART for six months during DOTS.</p

Diabetes in members of households with TB compared to those without TB.

Diabetes in members of households with TB compared to those without TB.</p