The benefits of investments to combat HIV, tuberculosis and malaria for primary health care, 2000-23: an economic modeling analysis

BackgroundGlobal 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 health care (PHC) utilization resulting from the scale-up of HTM services over 2000-2023 in 108 low- and middle-income countries. MethodsFor 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. FindingsOver 2000-2023, scale-up of HTM services averted an estimated 6{middle dot}9 (95% interval: 4{middle dot}4-10{middle dot}4) billion outpatient PHC visits and 3{middle dot}9 (2{middle dot}5-6{middle dot}1) billion inpatient bed-days, representing US$135 (70-248) 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{middle dot}4% of hospital bed capacity and 1{middle dot}6% of government health spending in 2023. These percentages were 22{middle dot}9% and 5{middle dot}1% respectively for low-income countries. InterpretationOver 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. FundingThe Global Fund.