PEPFAR TB Impact: Averting Millions of Cases and Deaths Among HIV Patients

PEPFAR TB Impact has been profound, with the U.S. President’s Emergency Plan for AIDS Relief averting an estimated 11.0 million tuberculosis (TB) cases and 2.1 million TB-related deaths among persons with HIV between 2003 and 2024.

The PEPFAR TB impact extends far beyond HIV, delivering substantial collateral benefits for tuberculosis control in high-burden countries. The analysis published by NEJM shows that more than one-third (42%) of total TB cases averted occurred between 2020 and 2024, with the direct contribution of TB-specific interventions rising sharply from 18% in 2021 to 46% in 2024.

How the Impact Was Measured

The study used a negative binomial generalized linear mixed model to quantify PEPFAR’s contribution. Researchers created a composite intervention-exposure variable that captured both the intensity and cumulative duration of PEPFAR-supported HIV and TB activities at the country level, while adjusting for gross domestic product, total health expenditure, and population size.

Accelerating TB Prevention

Since 2018, the scale-up of universal symptom screening, expanded access to TB diagnostics, and preventive treatment for eligible persons with HIV has dramatically increased PEPFAR TB impact. These direct interventions have worked synergistically with long-standing HIV investments, accelerating progress against a disease that remains the leading cause of death among people with HIV worldwide.

Value for Global Health Financing

The 11.0 million TB cases and 2.1 million deaths averted demonstrate the exceptional return on investment of integrated HIV-TB programming. These findings provide compelling evidence for sustained donor and domestic financing, particularly as countries increase their own funding for health programs.