The Global Fund estimates that health programs supported by the Fund resulted in 32 million lives saved for the period ending December 2018. This figure was included in Results Report 2019, which the Fund released on 19 September 2019.
The Results Report 2019 provides data for the year 2018. This is the second year of reporting using a revised methodology adopted by the Fund in 2018. Under the revised methodology, most of the results are reported on an annual basis (as opposed to a cumulative basis which the Fund previously used). The lives saved estimates is an exception to the new norm; it is still reported on a cumulative basis.
In 2018, the Global Fund estimated that 27 million lives were saved to end December 2017 in countries where the Fund invests. This indicates that an additional five million lives were saved between December 2017 and December 2018. However, the Global Fund cautions against comparing the 2018 estimates against the 2017 data. In a Note on Methodology included in the Results Report 2019, the Fund explained that:
“2018 marks the first year in the 2018-2020 grant implementation cycle. The country coordinating mechanism (CCM) … adapts performance framework agreements for each new grant cycle…. As the associated indicators identified by the CCMs can significantly change from one cycle to the next, some 2018 results are not directly comparable to the results of the previous year. This is particularly notable for HIV prevention services, which are an aggregation of a range of services determined by countries and tracked at national or subnational level.”
For this reason, we have refrained from making comparisons between end 2018 estimates and end 2017 data in this article.
(Note: A majority of grants emanating from the 2017-2019 allocations are being implemented over the period 2018-2020. However, this is not the case for all grants.)
The Results Report 2019 also includes some analysis of the data and describes some of the challenges that lie ahead. It is the last results report to be produced before the Sixth Replenishment Conference on 10 October in Lyon, France.
Peter Sands, the Global Fund’s Executive Director, said in a call with the Global Fund Advocate Network last week that the Results Report “provides an occasion to go back to [donors] with new news”. He said that the report demonstrates that the Global Fund continues “to deliver huge outcomes and impact, most notably in the 32 million lives saved,” but that the report also indicates why it is that the world needs to ‘step up the fight’.
“There’s enough sobering news in the Results Report that just continuing as we are is really not good enough.” The “double message” about enormous impact and ongoing huge need “is worth ensuring that everybody hears out of the report,” Sands said.
In addition to the 32 million lives saved estimate, other high-level results for the period ending in December 2018 are as follows:
|People receiving antiretroviral treatment||18.9 million|
|People with TB treated||5.3 million|
|Mosquito nets distributed||131 million|
In a note on its website, the Global Fund said that it reports full national results for the countries where it invests, rather than reporting solely on the specific projects or interventions it funds. “This reflects a core principle of the Global Fund: that we support national health programs and strategies to achieve national goals. By reporting full national results, we can show the impact of the programs we support together with all partners and demonstrate where countries are on the trajectory toward achieving 2030 targets to end the epidemics,” the Fund said.
In the balance of this article, we provide additional results for each of the three diseases.
Results for HIV
The number of new HIV infections in 2018 is estimated to be 1.7 million. The Global Fund said that this number is “unacceptably high” and that it is not dropping fast enough to meet the UNAIDS target of fewer than 500,000 people infected per year by 2020.
“Persistent gender and human rights barriers drive new infections and reduce uptake and retention of health services,” the Results Report 2019 said. As a result, people from key populations and their partners now account for over half of all new infections. Men who have sex with men, sex workers, prisoners, transgender people and people who inject drugs are up to 22 times more likely to acquire HIV than the general population.
Figure 1 (Source: Results Report 2019)
In addition, the report said, girls and young women age 15-24 in sub-Saharan Africa are twice as likely to be HIV-positive compared to young men of the same age. In the hardest-hit countries, the number is six times as high.
HIV drug resistance is an increasing global problem, the report said. In sub-Saharan Africa, over 10% of people starting antiretroviral therapy have a strain of HIV that is resistant to some of the most widely used first-line HIV drugs.
Other HIV-related results include the following:
- 719,000 HIV-positive mothers received medicines to prevent transmission to their babies; coverage increased from 43% in 2010 to 83% in 2018 (the target is 100% by 2020);
- 125 million HIV tests were taken; HIV-positive people with knowledge of their status increased from 70% in 2015 to 79% in 2018 (target: 90% by 2020);
- With 18.9 million people estimated to be on ART at end 2018, coverage has increased from 22% in 2010 to 62% in 2018 (target: 81% by 2020);
- The proportion of people living with HIV with suppressed viral load increased from 39% in 2015 to 53% in 2018 (target: 73% by 2020);
- 8.3 million people were reached with HIV prevention services in 2018, including 4.6 million persons from key populations and 1.8 million young people; and
- There were 1.5 million medical male circumcisions for HIV prevention in 2018.
Results for Tuberculosis
Figure 2 (Source: Results Report 2019)
With 5.3 million people estimated to be treated for TB in 2018, coverage increased from 49% in 2010 to 61% in 2017; and the treatment success rate reached 84% in 2016. The target for both coverage and treatment success rates is 90% by 2025.
Since the release of the World Health Organization (WHO) rapid communication on the new drug-resistant TB treatment regimen in August 2018, the Global Fund has provided $46.6 million to 18 countries through portfolio optimization to support transition to the new regimens.
Other TB-related results include the following:
- There were 114,000 people on treatment for multiple-drug-resistant TB (MDR-TB) in 2018. TB treatment coverage increased from 49% in 2010 to 61% in 2017, and the TB treatment success rate reached 84% in 2016 (targets: 90% MDR-TB treatment coverage and treatment success by 2030);
- There were 6,771 people with extensively drug-resistant TB on treatment in 2018;
- 332,000 HIV-positive TB patients received antiretroviral therapy during TB treatment in 2018; and
- 142,740 children in contact with TB patients received preventive therapy in 2018 in countries where the Global Fund invests.
Results for Malaria
Figure 3 (Source: Results Report 2019)
Other malaria-related results for 2018 include the following:
- 9.4 million pregnant women received preventive therapy for malaria;
- 6.7 million structures were covered by indoor residual spraying;
- 220 million suspected cases were tested; and
- 110 million cases of malaria were treated.
AIDSPAN COMMENT: When the Global Fund was reporting results on a cumulative basis, it was easy to draw comparisons from one year to the next and to detect trends. When the Fund introduced annual reporting in 2018 (for end 2017 results), it said that comparisons were not possible during the transition –– i.e. for 2017 vs 2016. However, it said, when the 2018 results were in, year-over-year comparisons could resume. (See, for example, the GFO article here.) Unfortunately, this has not happened. As indicated in this article, in Results Reporting 2019 the Fund explained that because 2018 is the first year of a new grant implementation cycle (2018-2020), at country level many of the indicators used to measure results will have changed. Does that mean that we will be able to do some limited year-over-year comparisons for 2019 and 2020, the second and third years of the cycle? Perhaps. But then we can expect more changes to the indicators in 2021, the first year of the next grant cycle. And won’t the indicators vary from country to country? It looks like it will no longer be possible to do year-over-year comparisons at the global level.
The Global Fund said that country-specific results are available on the Fund’s country pages, which can be accessed through its Data Explorer site. The Fund noted that the 2018 results might differ from previously published results due to retroactive updates and corrections.
- Methodology: The last section of the Results Report 2019 contains a brief Note on Methodology. A more elaborate Note on Methodology is contained in a separate document: Results Report 2019: Methodology Annex 1. The annex 1 document contains a comparison of results for selected services between end 2017 and end 2018, plus an explanation for some of the differences. Finally, an extensive explanation of the Global Fund’s reporting methodology is available on the Fund’s website here.
- A 1-page summary of the Results Report 2019 in English
- Sixth Replenishment Investment Case (full report; summary)