Stephanie Su

Background The Sustainable Development Goals (SDGs) include ending the epidemics of HIV, tuberculosis, and malaria by 2030. With 5 years remaining to meet this goal, and with the Global Fund to Fight AIDS, Tuberculosis andMalaria seeking funding for programmes in 2027–29, establishing what can be achieved through continued investment in combatting these diseases is crucial. We aimed to estimate the potential for impact by analysing the funding landscape and epidemiological situations of these three diseases, the costs of key programmes, and the extent of possible future progress in the countries eligible for Global Fund support.Method In this modelling study, we developed estimates of the financial resources needed in Global Fund-supported countries to combat HIV, tuberculosis, and malaria from the global plans produced by UNAIDS, the Stop TBPartnership, and WHO. Estimates of available resources in the coming years were obtained by assuming that national expenditure on the three diseases would grow in line with general governmental expenditures, that the GlobalFund would contribute an additional $18·0 billion, and that other developmental assistance would be at the same level in real terms as the average in the period 2020–22. Epidemiological and costing models for each of the three diseases were used to quantify the possible impact in Global Fund-eligible countries (including on aggregated mortality and incidence rates). The return on investment (ROI) was computed considering both the intrinsic value of health and the direct economic benefits of the reduced risk of morbidity and premature mortality. The analysis was completed at the end of 2024 with the latest available data, which pertained to the year 2023. The focus of the projection period was 2027–29, a period for which scale-up plans and funding have not yet been committed and the period when most of the resources raised by the eighth replenishment of the Global Fund would be used.Findings The total resource needs for the three diseases were estimated to be US$140·6 billion in 2027–29. We calculated that $111·3 billion (79%) of this need could be met from domestic financing ($69·7 billion), the GlobalFund ($18·0 billion), and other external donors ($23·6 billion). Optimal use of these available resources could save23 million lives and avert 400 million cases and new infections during 2027–29. The trajectory of the combined mortality rate for all diseases was projected to approach that needed to reach the SDG for 2030 (with a difference between the target in 2030 and the projection at the end of 2029 of between 1·5% and 15·5% of the normalised aggregated mortality rate), inequality in life expectancy between countries would be 7% lower by 2029, and189 million fewer hospital days and 572 million fewer outpatient visits would be needed in 2027–29, saving $1·1 billion.For every $1·00 invested, there could be up to $19·00 in intrinsic health value created or $3·50 in direct economic benefits.Interpretation Continued investments to combat HIV, tuberculosis, and malaria could yield enormous health gainsand a high return on investment. Realising these benefits will require continued growth in national expenditure anda broad maintenance of external financing for these diseases, including a successful replenishment of the GlobalFund in 2025.Funding The Global Fund.

Background Global investments to combat HIV, tuberculosis, and malaria (HTM) have delivered substantial health gains and may have reduced the burden placed by these diseases on the routine health system. We estimated the reduction in primary healthcare (PHC) utilization resulting from the scale-up of HTM services over 2000–2023 in 108 low- and middle-income countries.Methods and findings For each disease, we applied established mathematical models to quantify PHC utilization (outpatient visits and inpatient bed-days provided outside of HTM programs) by individuals with symptomatic HIV, tuberculosis, or malaria unable to access HTM-specific services. For each country, we estimated averted PHC utilization by comparing a scenario describing the actual scale-up of HTM services to a counterfactual scenario holding HTM service coverage constant at year 2000 levels. We applied published unit costs to estimate the averted costs resulting from reduced PHC utilization. Over 2000–2023, scale-up of HTM services averted an estimated 6.9 (95% uncertainty interval (UI) [4.4, 10.5]) billion outpatient PHC visits and 3.9 (95% UI [2.5, 5.9]) billion inpatient bed-days, representing US$135 (95% UI [71, 250]) billion in averted costs. These reductions were greatest in sub-Saharan Africa and East Asia and Pacific regions. Across study countries, these reductions represented a median of 4.4% of hospital bed capacity and 1.6% of government health spending in 2023. These percentages were 22.9% and 5.1%, respectively, for low-income countries. Our analysis did not consider changes in PHC services beyond utilization. Also, several inputs were missing in some countries, with missing values estimated using regression imputation.Conclusions Over recent decades, sustained investments in HTM services in high-burden settings have averted substantial PHC utilization and associated costs. These benefits should be considered when assessing investment impact.