The potential impact of reductions in international donor funding on tuberculosis in low-income and middle-income countries: a modelling study

作者：Rebecca A. Clark, Christopher Finn McQuaid, Alexandra S Richards, Roel Bakker, Tom Sumner, Tomos O. Prŷs‐Jones, Rein M G J Houben, Richard G White, Katherine C. Horton · 发表于：The Lancet Global Health · 年份：2025 · DOI：10.1016/s2214-109x(25)00232-3 · 被引用次数：50 · 研究领域：Tuberculosis Research and Epidemiology、Global Health and Surgery、International Development and Aid

BACKGROUND: Tuberculosis programmes in many settings rely heavily on international donor funding. In 2025, the United States Agency for International Development (USAID) was dismantled, and other countries announced cuts to overseas development assistance. We quantified the potential epidemiological impacts on the tuberculosis burden attributable to these reductions in funding. METHODS: We calibrated a deterministic tuberculosis model of Mycobacterium tuberculosis transmission, progression, and care to epidemiological indicators in selected low-income and middle-income countries. Calibration was done with the history matching with emulation method, implemented with the hmer package in R and the Approximate Bayesian computation Markov Chain Monte Carlo method. We projected three future scenarios with the following assumptions: that levels of funding in 2024 would continue, that USAID funding would be terminated from 2025, and that additional reductions in funding through The Global Fund to Fight AIDS, Tuberculosis and Malaria would occur (alongside termination of funding from USAID) in line with current donor announcements from 2025. We assumed a reduction in tuberculosis treatment initiation rates proportional to budget reductions for each scenario, estimating cumulative excess episodes of symptomatic tuberculosis and tuberculosis deaths for each scenario. FINDINGS: We modelled 79 countries, representing 91% of global tuberculosis incidence and 90% of global tuberculosis mort...