TB, HIV, and Malaria Treatment Rebound to Near Pre-Pandemic Levels, But Still Off Course  
Field visit at a TB clinic Karachi, Pakistan

The number of people on tuberculosis treatment rebounded to 5.3 million in 2021 and is nearing pre-pandemic levels of 5.5 million, according to a new Global Fund report.  That’s an encouraging sign of progress after treatment plummeted to just 4.5 million people in 2020, the report, released on Monday, notes. 

Overall, the new report shows the fight against HIV/AIDS and malaria, as well as tuberculosis, is rebuilding momentum since the pandemic-fueled sharp declines in diagnosis and treatment levels for the world’s three biggest infectious diseases. 

While the growth in HIV coverage levels remains steady, TB and malaria coverage have both declined in recent years. Declines in TB coverage are mostly due to disruptions caused by the COVID-19 pandemic, and declines in malaria coverage in sub-Saharan Africa may partly reflect better targeting of mosquito nets.

HIV program disruption ‘less than initially feared’ 

The world missed every single global HIV target for 2020, including that of reducing deaths to fewer than 500,000 per year. But the report states that this “could have been much worse.”

As a result of the Global Fund’s COVID-19 response mechanism (C19RM) for HIV programs, disruption to antiretroviral therapy was less than initially feared, the report states. 

The Global Fund C19RM’s prevented acute disruption to HIV/AIDS programs.

Some 23.3 million people received antiretroviral therapy for HIV in 2021, continuing the trend of a rising number of people on treatment for the virus.

The HIV prevention services helped 12.5 million people, including 5.8 million from populations most at risk and 6.1 million young people. The helped to recovered the ground lost in 2020 when prevention services dropped.

Globally, AIDS-related deaths fell 50% since 2010, down to 650,000 people in 2021. On prevention, progress in reducing new HIV infections remains slow: a 32% reduction since 2010, with 1.5 million people newly infected with the virus in 2021, compared to 2.2 million in 2010. New infections flatlined, and in some regions they increased.

Pandemic impacts tuberculosis 

The rebound of tuberculosis treatment is particularly good news in light of the harsh impact the pandemic had on the fight against TB. Resources for COVID-19 diagnosis and treatment drained those used for TB.

As a result, TB killed an estimated 1.5 million people (including people living with HIV) in 2020. That marked the first increase in a decade, derailing efforts to cut TB deaths by 35%. Additionally, TB remains the leading cause of death for people living with HIV. 

COVID-19 also harmed efforts to reduce the number of people who fall ill with TB but are not diagnosed, treated or reported. Health systems missed almost half of the people who fell ill with TB in 2020.

TB treatment coverage dropped in 2020 as a result of COVID-19 disruptions.

But in 2021, there was a sharp turnaround. Some 5.3 million people were treated for TB and 110,000 others were treated for drug-resistant TB last year.

In addition, 395,000 people who were in contact with TB patients received preventive therapy, while 283,000 HIV-positive TB patients were put on antiretroviral drugs. 

The report credits the recovery to US$159 million in funds invested in 2021 to support people with TB and to the Global Fund’s programs in 20 high-priority TB countries. 

“In the fight against TB, we are recovering from the 2020 losses,” it says.

Climate change and pandemic challenged malaria programs 

In 2020, malaria deaths rose by 12% compared with 2019, up to an estimated 627,000. Some 47,000 of the additional 69,000 deaths in 2020, or 68%, resulted from pandemic-caused service disruptions.

Climate change disrupted malaria programs by affecting the geographical distribution of plasmodium-carrying mosquitoes, which can cause malaria. 

To mitigate the impact of COVID-19, the Global Fund and its partners scaled up malaria program adaptations. They distributed mosquito nets door-to-door and made changes to the seasonal malaria chemo-prevention program for children under the age of five. They also increased community referrals and distribution of long-lasting insecticidal nets.

The Global Fund and its partners scaled up malaria programs to make up for losses during the pandemic.

As a result, 280 million suspected cases of malaria were tested in 2021, registering significant gains in efforts to ensure all people who may have malaria are diagnosed.

Health workers treated 148 million cases of malaria, continuing the recovery in efforts to ensure all people who are diagnosed with malaria are treated swiftly to prevent deaths.

Families received 133 million mosquito nets to protect from malaria. Additionally, 12.5 million pregnant women got preventive therapy for malaria to help keep them and their babies healthy.

Swift Global Fund response helped blunt pandemic impacts

The Global Fund says its swift response to COVID-19, providing more than $4.4 billion to fight the pandemic and mitigate its impact on HIV, TB, and malaria control, helped blunt COVID-19’s impact overall by helping countries put more resources into prevention campaigns and buying personal protective equipment, diagnostics, treatments and medical supplies. 

However, the Global Fund does not expect progress against the three diseases to fulfill the United Nations’ Sustainable Development Goals (SDGs) for 2030. 

“Although most countries that fight HIV, TB and malaria have started to recover from the ravages of COVID-19, we need to accelerate our efforts if we are to fully recover lost ground and get back on track towards ending these diseases by 2030,” said Peter Sands, the Global Fund’s executive director.

Global Fund to raise $18 billion to fund fight against the three diseases 

The report comes just ahead of Global Fund’s replenishment conference seeking US$18 billion for its next three-year cycle of programs and grants

The money is projected to save another 20 million lives between 2024 and 2026, Sands said, and strengthen health and community systems to reinforce pandemic preparedness.

Image Credits: Uzma Khan, Global Fund.

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