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GFO Issue 419



Alan Whiteside

Article Type:

Article Number: 2

Over 20 years in fighting HIV, TB and Malaria; pandemic investments paying off

ABSTRACT In the week preceding the Seventh Replenishment Conference, the Global Fund has released its 2022 Results Report. It shows that progress has rebounded following the setbacks due to COVID-19 and that investments in addressing the pandemic have paid off. However, we are still far from being able to meet the Sustainable Development Goals’ targets. All eyes will be on the Seventh Replenishment being held this week and whether or not the Fund has succeeded in obtaining the minimum needed to support the response to HIV, TB and malaria

On 12 September, a week prior to the start of the Seventh Replenishment Conference, the Global Fund set the scene by launching its 2022 Results Report and thereby demonstrating why investing in the Global Fund has an impact.

According to the Results Report, in 2021 the Global Fund provided 30% of all international funding to HIV, 76% of all international funding to TB and 63% of all international funding to malaria. As of June 2021, 72% of Global Fund investments were directed to sub-Saharan Africa, 19% to Asia and the Pacific, 3% of Eastern Europe and Central Asia, 3% to Latin America and the Caribbean and 2% to North Africa and the Middle East.

However, in 2020, the COVID-19 pandemic had a devastating effect on the fight against the three diseases, leading to the decline of key programmatic results across HIV, TB and malaria (HTM) for the first time in the history of the Global Fund. When the COVID-19 pandemic hit countries where the Global Fund works, the partnership rapidly mounted a response to deliver additional resources. This year, the new report shows those investments paid off and recovery is underway.

By the end of 2021, says the Report, programs supported by the Global Fund partnership had saved 50 million lives. Since 2002, investments in HTM together with health system strengthening, have cut the combined death rate from the three diseases by more than half.

Figure 1. Life expectancy in 15 sub-Saharan African countries

Increase from 2002 to 2019

Every life saved, and every infection averted, has a multiplier effect across families, communities and entire nations. The Global Fund goes on to praise the diverse actors who comprise the Global Fund partnership – communities, governments, the private sector, civil society and technical partners –  and are essential to the organization’s success.

Report highlights

The Global Fund provides 30% of international financing for HIV programs. In countries where the Global Fund invests, AIDS-related deaths reduced by 70% between 2002 and 2021. The percentage of people in need of antiretroviral therapy (ART) who received it has significantly increased over the past decade, from 23% in 2010 to 75% in 2021. When COVID-19 interrupted HIV services, the Global Fund partnership put measures in place to mitigate its impact through an additional funding stream, the COVID-19 Response Mechanism (C19RM). In Global Fund-supported countries, HIV testing services for groups in greatest need as well as prevention services started to recover in 2021.

HIV: Key results in 2021

  • 23.3 million people on ART
  • 70.8 million HIV tests taken (12.6 million by  priority and key populations)
  • 12.5 million people reached with HIV prevention services including 5.8 million people from populations most at risk and 6.1 million young people
  • 670,000 mothers living with HIV received medicine to keep them alive  and  prevent transmitting HIV to their babies
  • 1.1 million voluntary medical male circumcisions for HIV prevention
  • 69% of people living with HIV (PLHIV) had a suppressed viral load.


The Global Fund provides 76% of international financing for TB programs. In countries where the Global Fund invests, TB deaths (excluding PLHIV) dropped by 21% between 2002 and 2020. Together with technical partners and implementing countries, the Global Fund continues to spearhead approaches to accelerate TB testing and treatment and identify more “missing” people with TB. Thanks to the Global Fund partnership, TB programs began to recover in 2021 from the impact of the COVID-19 pandemic, with gains in the number of people on treatment for TB.

TB: Key results in 2021

  • 5.3 million people treated for TB
  • 110,000 people treated for drug-resistant TB, a trajectory of recovery            following the sharp drops in 2020
  • 1.6 million people on treatment for extensively drug-resistant TB
  • 395,000 people in contact with TB patients provided with preventive therapy, expanding efforts to prevent people at the highest risk of TB from progressing from TB infection to disease
  • 283,000 HIV-positive TB patients put on antiretroviral drugs (ARVs): TB is the leading cause of death among PLHIV

The Global Fund provides 63% of international financing for malaria programs. In countries where the Global Fund invests, malaria deaths reduced by 26% between 2002 and 2020. In 2021, progress continued in offering malaria prevention services such as mosquito nets and seasonal malaria chemoprevention to more people at risk of the disease. In 2021, Global Fund-supported programs recovered from declines in 2020, with testing and treatment for malaria registering gains.

Malaria: Key results in 2021

  • 280 million suspected cases of malaria tested, registering significant gains in efforts to ensure all people who may have malaria are diagnosed
  • 10.1 million structures covered by indoor residual spraying
  • 148 million cases of malaria treated, continuing the recovery in efforts to ensure all people who are diagnosed with malaria are treated swiftly to prevent deaths
  • 133 million mosquito nets distributed to protect families from malaria
  • 12.5 million pregnant women provided with preventive therapy for malaria, saving women’s lives and preventing adverse birth outcomes


Strengthening systems for health

Resilient and sustainable systems for health support the Fund’s determination to defeat today’s infectious diseases and respond to future threats. The Global Fund is the world’s largest multilateral provider of grants for strengthening systems for health. Over the 2021-2023 implementation period, it is investing $4.9 billion, or $1.5 billion a year, in formal and community health systems through core grants and C19RM – about one-third of its total investments.

During the allocation period 2020-2022 the Global Fund invested $16 million to support civil society and communities most affected by the three diseases to participate and engage in Global Fund and related national processes across the grant cycle. This includes country dialogue, funding request development, grant-making, and grant implementation and oversight.

In many rural areas, community health workers are the cornerstone of the formal health system. Their vital role in communities became even more apparent during the COVID-19 pandemic and, as a result, the Global Fund doubled its investment in community health worker systems in the current funding cycle to $377 million. It aims to further increase its investments in this area.

Given the critical role that community systems play in the fight against infectious diseases, and the importance of addressing human rights abuses and gender-based violence, the Global Fund has put a particular focus on supporting initiatives in these areas as part of C19RM investments.

COVID-19 and other crises

To end HTM as public health threats and address emerging dangers to global health security, the Global Fund needs to reach the most vulnerable people with prevention and treatment services, wherever they are. That means greater attention on challenging operating environments – countries or regions that experience infectious disease outbreaks, natural disasters, armed conflicts or civil unrest, weak governance, climate change-related crises and/or mass displacement.

The Global Fund responded swiftly to COVID-19, providing significant funding to country responses through C19RM and leveraging its expertise and strong global networks. Since March 2020, the Global Fund has invested more than $4.4 billion to fight the pandemic and mitigate its impact on HTM, as well as allowing flexibilities regarding reprogramming existing grant activities. The funding enabled countries to rapidly adapt existing programs, purchase personal protective equipment, diagnostics, treatments and medical supplies and deploy prevention campaigns. This quick response helped avoid the worst-case scenario of a surge in deaths and cases across the three diseases.

Figure 2. COVID-19 Response Mechanism awards by type of intervention, as July 2022