Beware the Global Fund Procurement Cliff

For the last two decades, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has helped to scale up access to affordable, quality-assured medicines and diagnostics that have saved millions of lives. However, this progress is under threat.

Following stagnating donor funding globally, the Global Fund has in recent years revised its policies that determine funding for countries, including its funding allocation methodology and its Sustainability, Transition and Co-financing (STC) policy. As a result, countries are shifting from Global Fund-supported mechanisms to national processes for the purchase of medicines and diagnostics for the three diseases.

Médecins Sans Frontières (MSF) believes this shift is often premature and poses significant risks to people’s access to quality medicines and diagnostics, with dire implications for people with HIV, tuberculosis (TB), or malaria.

This policy brief analyses risks to the affordability, quality and supply of medicines and diagnostics, and provides recommendations for the Global Fund, affected countries, donor countries and the World Health Organization to collectively address these challenges.

HIV/AIDSmalariatuberculosis The Global Drug Facility HIV/AIDSTuberculosis Technical brief
A coalition of civil society members and organisations, including MSF Access Campaign, carried out several advocacy related activities, including protests, at The 49th Union World Conference on Lung Health in The Hague, The Netherlands 24-27 October 2018.  Photos are from a protest on 24 October 2018 where activists brought attention to the drug procurement challenges countries face when they shift from Global Fund support to domestic procurement and co-financing issues. Photograph by Anna McGurk

Safeguarding supply of affordable quality medicines and diagnostics in context of risky transitions and co-financing


A rapid TB test for people living with HIV

Tuberculosis (TB) is the leading cause of death among people living with HIV. Only around 50 per cent of people living with HIV are properly diagnosed with TB.

A rapid, true point-of-care urine-based TB test (Determine TB LAM Ag) can help. TB LAM can quickly diagnose TB in people with AIDS/advanced HIV disease, including those who cannot produce sputum. TB LAM was recommended by the World Health Organization (WHO) in 2015 to aid in the diagnosis of TB in both adults and children living with HIV. However, scale-up of this lifesaving test is too slow and benefits too few people.

This technical brief analyses gaps in the diagnosis of TB for people living with HIV, describes the critical role TB LAM testing can play in saving lives, and provides recommendations for governments to implement and rapidly scale up access to testing.

HIV/AIDSTuberculosis Technical brief
An MSF nurse performs a TB LAM test using a patients’ urine to test the presence of TB in a severely ill AIDS patient. Photograph by Albert Masias
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