After a decade of strong commitments to fight the twin epidemics of HIV and tuberculosis (TB), a decline in international funding and the rapid shifting of the financial burden to affected countries is in danger of reversing lifesaving gains and causing an ‘epidemic rebound’ in some countries. To highlight this reality and the expanding gaps in the HIV and TB responses, MSF produced a report analyzing the financial and systemic challenges in 9 countries where it runs HIV/TB programmes: Central African Republic, Democratic Republic of Congo, Eswatini, Guinea, Kenya, Malawi, Mozambique, Myanmar, Zimbabwe.
Published ahead of the Global Fund’s 6th replenishment conference in Lyon (France, 8-10 October 2019), the report documents how international funding shortfalls and insufficient domestic resources availability are already causing wide-ranging gaps in HIV and TB diagnosis, prevention and care services; stockouts of essential medicines; and are threatening programmes targeting people with specific needs, such as migrants and people with advanced HIV.
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.
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.