Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

Abstract

BackgroundSince 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund.MethodsGlobal Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models.ResultsBy end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented.ConclusionsThese results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.

Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund's Approach

“…An earlier estimation using a similar methodology indicated that at the end of 2007, DOTS was responsible for 67% of all lives saved by Global Fund–supported programmes, while ART and ITNs contributed 28% and 5%, respectively [8]. However, these proportions will have changed due to the extensive scale-up of ITNs since 2008 leading to greater reductions in mortality due to malaria [9].…”

Implementing locally appropriate guidelines and training to improve care of serious illness in Kenyan hospitals: a story of scaling-up (and down and left and right)

“…Examples include essential neonatal care, essential obstetric care, malaria case management, case management of severe malnutrition and management of the HIV infected child. Reported examples of successful scaling-up of such packages are usually drawn from large, internationally well-funded programmes in fields such as HIV 5. In contrast, support for widespread implementation of cross-cutting interventions such as WHO/UNICEF's Integrated Management of Childhood Illnesses can be half-hearted even if the approach is formally adopted at policy level 6 7…”

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“…The survival assumptions follow those used by UNAIDS in their routine estimates on the global HIV epidemic 23. In addition to the GFATM annual reports, there has also been an impact assessment published as a journal article by Komatsu and colleagues 24. The methods used in the article differed only slightly from those used in the official GFATM reports.…”