Potential pediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025-2034: a mathematical modelling study

IntroductionChildren experience elevated risks of developing and dying from tuberculosis (TB). We estimated the additional pediatric TB cases and deaths that could occur over 2025-2034 if programmes supported by United States bilateral health aid and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) are discontinued. MethodsWe collated data on funding sources for TB and HIV programs in low- and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models for 130 countries, we projected the discontinuation of TB and HIV treatment services under several funding reduction scenarios, and how this would affect pediatric TB exposure and treatment access. We projected pediatric TB incidence and mortality over 2025-2034 to calculate the impact of funding reductions. ResultsCompared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid was projected to result in an additional 2.5 million (95% uncertainty interval: 1.8-3.3) pediatric TB cases and 340,000 (240,000-460,000) deaths over 2025-2034. Withdrawal of US support to the Global Fund and reduction in non-US contributions was projected to result in an additional million 8.9 (6.9-11.5) pediatric TB cases and 1.5 million (1.1-2.0) deaths, more than double the number expected with continued service levels. Impacts were greatest in Sub-Saharan Africa and South-East Asia. Restoration of services in 2026 led to a substantially smaller number of additional deaths. FindingsWithout actions to restore discontinued services, cuts to health aid for TB and HIV programs could result in large numbers of childhood TB deaths over the next decade.