Funding cuts could reverse years of TB and HIV progress in South Africa

Reductions in United States (US) funding for tuberculosis (TB) and HIV programmes have raised alarms about the future of care in South Africa and beyond. Research led by Mmamapudi Kubjane used mathematical modelling to explore what might happen if those funding cuts were allowed to disrupt services without mitigation. The study focused on long-term effects over 2025–2035 and built scenarios with input from stakeholders to reflect realistic ranges of disruption. Those scenarios considered both minimal and maximal interruptions to key services that keep people healthy and illnesses under control. Specifically, the modelling examined impacts on preventive therapy for people living with HIV (PLHIV), TB testing, TB treatment initiation, and antiretroviral therapy (ART) coverage. By simulating how gaps in these services would change infection and death rates, the team aimed to show potential future harms and the size of the problem facing health systems if funding shortfalls are not addressed. The approach was intended to inform policymakers and program leaders about the stakes of funding decisions and the urgency of action.

The team ran stakeholder-informed scenarios with mathematical models that tracked TB and HIV outcomes under different disruption levels. They assumed both minimal and maximal reductions in services, including preventive therapy for PLHIV, TB testing, TB treatment initiation, and ART coverage. The results over the decade from 2025 to 2035 were stark. Reduced ART coverage alone was projected to lead to between 235,000 and 1,000,000 additional HIV infections. Among people living with HIV, the model estimated a 12–41% increase in TB episodes and a 21–72% rise in TB deaths. Looking at the whole population, the study projected 220,000–730,000 additional TB episodes and 67,000–225,000 TB deaths if funding disruptions went unmitigated. These ranges reflect the difference between smaller and larger service interruptions and show how sensitive TB and HIV control are to continuous program support.

The implications are clear: funding interruptions could erase years of progress and cause substantial avoidable illness and death. Although the model did not include any mitigation measures, the authors note that early responses in South Africa have already included increased diagnostic testing and additional domestic funding. The study emphasizes that rapid and sustained programmatic responses and reliable funding are essential to prevent the projected setbacks. Without prompt action to restore and protect services such as preventive therapy for PLHIV, TB testing, TB treatment initiation, and ART coverage, health systems may face a large and prolonged increase in both TB and HIV burden. Policymakers and donors can use these modeled outcomes to weigh the human cost of funding decisions and to prioritize immediate measures that keep critical services running.