Projected long-term impacts of US funding cuts on TB and HIV in South Africa and the TB Programme response

BackgroundReductions in United States (US) funding for tuberculosis (TB) and HIV programmes have raised concerns and challenges for TB care and management in South Africa and globally. We used mathematical modelling to illustrate the potential impact of unmitigated funding disruptions, estimating long-term effects on TB incidence and mortality over 2025-2035. MethodsStakeholder-informed scenarios were modelled, assuming both minimal and maximal disruptions to key TB and HIV services, including preventive therapy for people living with HIV (PLHIV), TB testing, TB treatment initiation, and antiretroviral therapy (ART) coverage. Results and discussionBetween 2025 and 2035, reduced ART coverage was projected to result in 235,000-1,000,000 additional HIV infections; and a 12-41% increase in TB episodes, and 21-72% rise in TB deaths among people living with HIV. Overall, 220,000-730,000 additional TB episodes and 67,000-225,000 TB deaths are anticipated, potentially reversing years of progress. Although mitigation efforts were not included in the model, early responses in South Africa have involved increased diagnostic testing and additional domestic funding. To maintain progress in TB and HIV control, rapid and sustained programmatic responses and funding are essential to prevent substantial setbacks and avert avoidable illness and death.