Domestic and donor fi nancing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 2002–11, and requirements to meet 2015 targets

Background Progress in tuberculosis control worldwide, including achievement of 2015 global targets, requires adequate fi nancing sustained for many years. WHO began yearly monitoring of tuberculosis funding in 2002. We used data reported to WHO to analyse tuberculosis funding from governments and international donors (in real terms, constant 2011 US$) and associated progress in tuberculosis control in low-income and middle-income countries between 2002 and 2011. We then assessed funding needed to 2015 and how this funding could be mobilised. Methods We included low-income and middle-income countries that reported data about fi nancing for tuberculosis to WHO and had at least three observations between 2002 and 2011. When data were missing for specifi c country–year combinations, we imputed the missing data. We aggregated country-specifi c results for eight country groups defi ned according to income level, political and economic profi le, geography, and tuberculosis burden. We compared absolute changes in total funding with those in the total number of patients successfully treated and did cross-country comparisons of cost per successfully treated patient relative to gross domestic product. We estimated funding needs for tuberculosis care and control for all low-income and middle-income countries to 2015, and compared these needs with domestic funding that could be mobilised. Findings Total funding grew from$1·7 billion in 2002 to $4·4 billion in 2011. It was mostly spent on diagnosis and treatment of drug-susceptible tuberculosis. 43 million patients were successfully treated, usually for$100–500 per person in countries with high burdens of tuberculosis. Domestic funding rose from $1·5 billion to$3·9 billion per year, mostly in Brazil, Russia, India, China, and South Africa (BRICS), which collectively account for 45% of global cases, where national contributions accounted for more than 95% of yearly funding. Donor funding increased from $0·2 billion in 2002 to$0·5 billion in 2011, and accounted for a mean of 39% of funding in the 17 countries with the highest burdens (excluding BRICS) and a mean of 67% in low-income countries by 2011. BRICS and upper middleincome countries could mobilise almost all of their funding needs to 2015 from domestic sources. A full response to the tuberculosis epidemic to 2015, including investments to tackle multidrug-resistant tuberculosis, will require international donor funding of $1·6–2·3 billion each year. Interpretation Funding for tuberculosis control increased substantially between 2002 and 2011, resulting in impressive and cost-eff ective gains. The increasing self-suffi ciency of many countries, including BRICS, which account for almost half the world’s tuberculosis cases, is a success story for control of tuberculosis. Nonetheless, international donor funding remains crucial in many countries and more is needed to achieve 2015 targets

Precision medicine and public health interventions: tuberculosis as a model?

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Regimens to treat multidrug-resistant tuberculosis:past, present and future perspectives

Over the past few decades, treatment of multidrug-resistant (MDR)/ extensively drugresistant (XDR) tuberculosis (TB) has been challenging because of its prolonged duration (up to 2024 months), toxicity, costs and sub-optimal outcomes. After over 40 years of neglect, two new drugs (bedaquiline and delamanid) have been made available to manage difficult-to-treat MDR-/XDR-TB cases. World Health Organization (WHO) guidelines published in March 2019 endorsed the possibility of treating MDR-TB patients with a full oral regimen, following previous guidelines published in 2016 which launched a shorter regimen lasting 9-10 months.The objectives of this article are to review the main achievements in MDR-TB treatment through the description of the existing WHO strategies, to discuss the main ongoing trials and to shed light on potential future scenarios and revised definitions necessary to manage drug-resistant TB.</p

Migrants' health: Building migrant-sensitive health systems

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Tuberculosis and the strategy for the New Millennium: not simply “more of same”

Since the beginning of human history, tuberculosis (TB) has threatened the wellbeing of mankind. The last Global Tuberculosis Report, published by the World Health Organization (WHO) in 2013, highlighted the significant burden in morbidity and mortality that Mycobacterium tuberculosis still bears in the world today [1]...

tuberculosis epidemiology of

Tuberculosis is a disease caused by bacilli belonging to the Mycobacterium tuberculosis complex, which includes the species Mycobacterium tuberculosis (most frequently detected in human beings), Mycobacterium africanum, and Mycobacterium bovis. It is primarily an airborne disease. Mycobacteria enter into the human airways through the inhalation of droplet nuclei, i.e., particles containing mycobacteria aerosolized by coughing, sneezing, talking, or singing. Other rare, recognized ways of transmission are the ingestion of cow milk contaminated by Mycobacterium bovis (frequent route of transmission in the past), cutaneous inoculation in laboratory workers and pathologists, and sexual intercourse [1]

COVID-19 VACCINES: EVIDENCE, CHALLENGES AND THE FUTURE

Through an unprecedented research and development process, in early 2021, just one year after the COVID-19 pandemic started devastating the world, there are several vaccines commercially available or in advanced phase of testing, each with its own characteristics and challenges. For the first time in the history of vaccination, a global immunization programme has started at a time of intense pandemic activity characterized by high virus transmission, facilitating selection of variants potentially able to escape the vaccine-induced antibody response. The reality is that one cannot rely on a single vaccine when dealing with a pandemic emergency: the urgent need of billions of doses clashes with the production capacity of the pharmaceutical industry. There is therefore no ideal vaccine, but there are many good vaccines to be used immediately. Today, &nbsp;the international debate about COVID-19 vaccines is the hottest topic in global health whether it relates to technical and scientific issues or to the ethical aspects of access to vaccinations for all. This article aims at reviewing the status of vaccines that are used, or about to be used, in immunization campaigns worldwide

No antimicrobial resistance research agenda without tuberculosis.

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Implementing the Global Plan to Stop TB, 2011–2015 – Optimizing Allocations and the Global Fund’s Contribution: A Scenario Projections Study

CITATION: Korenromp, E. L. et al. 2012. Implementing the Global Plan to Stop TB, 2011-2015 - optimizing allocations and the Global Fund's contributions : a scenario projections study. PLoS ONE, 7(6): e38816, doi:10.1371/journal.pone.0038816.The original publication is available at http://journals.plos.org/plosoneBackground: 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.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038816Publisher's versio