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Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by
Nicolas A Menzies1, Tyler S Brown2, Jeffrey W Imai-Eaton3
1Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Insights
Cuts to global health aid could lead to millions of additional childhood tuberculosis cases and deaths. Restoring funding for tuberculosis (TB) and HIV programs is crucial to prevent a significant increase in pediatric TB mortality.
Area of Science:
- Global Health
- Epidemiology
- Public Health Policy
Background:
- Children face a disproportionately high risk of tuberculosis (TB) mortality.
- Current TB and HIV programs in low- and middle-income countries rely heavily on international health aid.
Purpose of the Study:
- To estimate the potential increase in pediatric TB cases and deaths between 2025 and 2034.
- To assess the impact of discontinuing health aid from US bilateral sources and The Global Fund.
Main Methods:
- Utilized transmission-dynamic models for TB and HIV in 130 countries.
- Simulated funding reduction scenarios for TB and HIV treatment services.
- Projected pediatric TB incidence and mortality under various aid withdrawal scenarios.
Main Results:
- Discontinuation of US aid could cause 2.5 million additional pediatric TB cases and 340,000 deaths.
- Combined withdrawal of US and Global Fund support could lead to 8.9 million additional cases and 1.5 million deaths.
- The African and South-East Asia regions face the greatest impact; service restoration in 2026 could significantly reduce excess deaths.
Conclusions:
- Cuts to health aid for TB and HIV programs risk millions of additional childhood TB cases and deaths.
- Urgent action is needed to restore funding and services to prevent a major increase in pediatric TB burden.
Background:
Children are at increased risk of developing and dying from tuberculosis. We aimed to estimate the additional paediatric tuberculosis deaths that could occur over 2025-34 if programmes supported by US bilateral health aid and The Global Fund to Fight AIDS, Tuberculosis, and Malaria are discontinued.
Methods:
For this modelling study we collated data on funding sources for tuberculosis and HIV programmes in low-income and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models of tuberculosis and HIV for 130 countries, we projected the discontinuation of tuberculosis and HIV treatment services under several funding reduction scenarios, and how this would affect paediatric (ages 0-14 years) tuberculosis exposure and treatment access. We projected paediatric tuberculosis incidence and mortality over 2025-34 to calculate the impact of funding reductions.
Findings:
Compared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid is projected to result in an additional 2·5 million (95% uncertainty interval [UI] 1·8-3·3) paediatric tuberculosis cases and 340 000 (240 000-460 000) tuberculosis deaths over 2025-34. Withdrawal of US support to The Global Fund and reductions in non-US contributions are projected to result in an additional 8·9 million (95% UI 6·9-11·5) paediatric tuberculosis cases and 1·5 million (1·1-2·0) tuberculosis deaths, more than double the number of paediatric tuberculosis deaths expected with continued service levels (1·10 million [0·89-1·38]). Impacts were greatest in the WHO African and South-East Asia regions. Restoration of services in 2026 was projected to lead to a substantially smaller number of additional deaths (39 000 [95% UI 29 000-51 000]).
Interpretation:
Without actions to restore discontinued services, cuts to health aid for tuberculosis and HIV programmes could result in millions of additional childhood tuberculosis cases and deaths in low-income and middle-income countries over the next decade.
Funding:
None.
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