[The role of the Global Fund to Fight AIDS, Tuberculosis and Malaria in the development of global health and its collaboration with China].

The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) has become an increasingly active and influential organization in global health during the past two decades. It is now playing an increasingly important role in the prevention and control of major infectious diseases, international financing for health, public procurement market development across the world. The article outlines the basic architecture of the Global Fund, including its overall information, financing mechanism, operational models and key experiences accumulated. Based on previous cooperation, the article analyzes the importance of the long-term partnership between China and the Global Fund, and proposes policy suggestions to achieve more win-win outcomes in the near future.

Can voluntary pooled procurement reduce the price of antiretroviral drugs? a case study of Efavirenz.

PURPOSE: : A number of strategies have aimed to assist countries in procuring antiretroviral therapy (ARV) at lower prices. In 2009, as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) commenced a voluntary pooled procurement scheme, however, the impact of the scheme on ARV prices remains uncertain. This study aims to estimate the effect of VPP on drug prices using Efavirenz as a case study. METHODS: This analysis uses WHO Global price report mechanism (GPRM) data from 2004 to 2013. Due to the highly skewed distribution of drug Prices, a generalized linear model (GLM) was used to conduct a difference-in-difference estimation of drug price changes over time. RESULTS: These analyses found that voluntary pooled procurement reduced both the ex-works price of generic Efavirenz and the incoterms price by 16.2 and 19.1%, respectively ( P < 0.001) in both cases). The year dummies were also statistically significant from 2006 to 2013 ( P < 0.001), indicating a strong decreasing trend in the price of Efavirenz over that period. CONCLUSION: Voluntary pooled procurement significantly reduced the price of 600 mg generic Efavirenz between 2009 and 2013. Voluntary pooled procurement therefore offers a potentially effective strategy for the reduction in HIV drug prices and the improvement of technical efficiency in HIV programming. Further work is required to establish if these findings hold also for other drugs.

Investing to end epidemics: the role of the Global Fund to control TB by 2030.

The Global Fund to fight AIDS, Tuberculosis and Malaria provides over three-quarters of all international financing towards TB programs with US$4.7 billion disbursed, supporting provision of treatment for 13.2 million patients with smear-positive TB and 210 000 patients with multidrug-resistant TB in over 100 countries since 2002. In 2013, the Global Fund launched a new funding model that, among others, is advancing strategic investments to maximize impact, addressing 'missing' TB cases, enhancing a synergistic response to TB/HIV dual epidemics, and building resilient and sustainable systems for health. A new Global Fund Strategy is under development through consultation with various stakeholders, with which the Global Fund will work to play a more catalytic role and foster innovations to end the TB epidemic.

The Global Fund to Fight AIDS, Tuberculosis and Malaria's investments in harm reduction through the rounds-based funding model (2002-2014).

BACKGROUND: Harm reduction is an evidence-based, effective response to HIV transmission and other harms faced by people who inject drugs, and is explicitly supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In spite of this, people who inject drugs continue to have poor and inequitable access to these services and face widespread stigma and discrimination. In 2013, the Global Fund launched a new funding model-signalling the end of the previous rounds-based model that had operated since its founding in 2002. This study updates previous analyses to assess Global Fund investments in harm reduction interventions for the duration of the rounds-based model, from 2002 to 2014. METHODS: Global Fund HIV and TB/HIV grant documents from 2002 to 2014 were reviewed to identify grants that contained activities for people who inject drugs. Data were collected from detailed grant budgets, and relevant budget lines were recorded and analysed to determine the resources allocated to different interventions that were specifically targeted at people who inject drugs. RESULTS: 151 grants for 58 countries, plus one regional proposal, contained activities targeting people who inject drugs-for a total investment of US$ 620 million. Two-thirds of this budgeted amount was for interventions in the "comprehensive package" defined by the United Nations. 91% of the identified amount was for Eastern Europe and Asia. CONCLUSION: This study represents an updated, comprehensive assessment of Global Fund investments in harm reduction from its founding (2002) until the start of the new funding model (2014). It also highlights the overall shortfall of harm reduction funding, with the estimated global need being US$ 2.3 billion for harm reduction in 2015 alone. Using this baseline, the Global Fund must carefully monitor its new funding model and ensure that investments in harm reduction are maintained or scaled-up. There are widespread concerns regarding the withdrawal from middle-income countries where harm reduction remains essential and unfunded through other sources: for example, 15% of the identified investments were for countries which are now ineligible for Global Fund support.

Financing the response to HIV among gay men and other men who have sex with men: Case studies from eight diverse countries.

Despite reductions in the number of new HIV infections globally, the HIV epidemic among men who have sex with men (MSM) is expanding. This study characterises financing of HIV programmes for MSM and the impact of criminalisation on levels of funding, using data from five countries that criminalise same-sex sexual practices (Ethiopia, Mozambique, Guyana, India and Nigeria) and three that do not (China, Ukraine and Vietnam). For each country, all publicly available documents from the Global Fund to Fight AIDS, Tuberculosis and Malaria for approved HIV/AIDS grants in Rounds 5-9 and Country Operational Plans detailing investments made through the President's Emergency Plan for AIDS Relief (PEPFAR) from US fiscal year (FY) 2007-2009 were examined. Eleven of 20 HIV proposals to the Global Fund contained programmes for MSM totalling approximately $40 million or 6% of proposed budgets. In six countries providing activity-level data on MSM programming, PEPFAR funding that served this population and others ranged from $23.3 million in FY2007 to $35.4 million in FY2009, representing 0.5-25.9% of overall, non-treatment funding over this period. Countries that criminalise same-sex sexual practices spend fewer resources on HIV programmes serving MSM. However, they also show consistent underfunding of programmes serving MSM regardless of context or geography.

Grant Performance and Health Financing: Analysis of 12 Years of Financing Decisions at the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Abstract-The Global Fund to Fight AIDS, Tuberculosis and Malaria ("the Global Fund") was established to attract, manage, and disburse additional financial resources toward Millennium Development Goal (MDG) 6. To increase the efficiency and impact of resources provided, performance-based financing (PBF) was included among the founding principles of the Global Fund. Since 2002, the Global Fund has disbursed over 28 billion USD to 145 countries or regional programs worldwide. This article investigates the degree to which PBF principles were followed in practice as well as the equity implications for the Global Fund's grant portfolio. We obtained performance and financial data on all disbursements (N = 6,064) and grant renewals (N = 892) between 2003 and 2014. Multivariate regression analysis was used to estimate the associations between performance ratings and financing amounts. The dependent variable was the fraction of original budgeted amount disbursed or renewed by the Global Fund. The main independent variable was the performance rating received by the grant. We also compared average funding shares by country income group before and after PBF adjustments. Our analysis found that lower performance ratings were associated with a smaller amount of the next period's budget disbursed; in addition, lower ratings were associated with a higher probability of the grant not being renewed after two years of implementation and a smaller proportion of recommitted funds. Low and lower-middle income countries obtained marginally lower grant performance ratings but still received 90% of the total grant renewal amounts from the Global Fund. These results suggest that the Global Fund has succeeded in implementing PBF principles over the past 12 years without shifting resources away from lower-income countries. Larger impact may be possible in the long run if health outcomes rather than only outputs or coverage indicators are also incentivized in PBF contracts between countries and the Global Fund.

Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis.

The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.

Итоговый документ: межрегиональный семинар по подготовке к переходу на внутреннее финансирование ответных мер на ТБ, ВИЧ и малярию: Тбилиси, Грузия, 17–19 октября 2018 г.

Межрегиональное рабочее совещание по вопросам оказания странам поддержки в подготовкек переходу от внешнего финансирования (для реализации мер по борьбе с туберкулезом, ВИЧинфекцией и малярией) было организовано совместно с Европейским региональным бюро ВОЗ,штаб-квартирой ВОЗ, Глобальным фондом для борьбы со СПИДом, туберкулезом и малярией иАгентством США по международному развитию. В настоящем документе перечисленыпрактические рекомендации для стран и партнеров, выработанные по итогам рабочегосовещания на основе обмена примерами передовой практики, обсуждения общих проблем иизвлеченных уроков.

Outcomes document: interregional workshop in preparation for transitioning towards domestic financing in TB, HIV and Malaria response: Tbilisi, Georgia, 17–19 October 2018

An interregional workshop to support countries to prepare for transition from external financing (particularly for the tuberculosis, HIV and malaria responses) was organized jointly by the WHO Regional Office for Europe, WHO headquarters, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Agency for International Development. This document lists the actionable recommendations for countries and partners that resulted from the workshop via the exchange of good practices, common challenges and lessons learned.

Межрегиональный семинар по подготовке к переходу на внутреннее финансирование ответных мер на ТБ, ВИЧ и малярию: Тбилиси, Грузия, 17–19 октября 2018: отчет о семинаре

Межрегиональный семинар по подготовке к переходу на внутреннее финансирование ответных мер на ТБ, ВИЧ и малярию, организованный совместно Европейским региональным бюро ВОЗ, штаб-квартирой ВОЗ, Глобальным фондом для борьбы со СПИДом, туберкулезом и малярией и Агентством США по международному развитию, проводился 17–19 октября 2018 г. в Тбилиси, Грузия. Основная задача семинара состояла в предоставлении странам и ключевым партнерамплатформы для обмена передовым опытом, обсуждения полученных уроков и общих проблемпри переходе на внутреннее финансирование, а также определения последующих шагов ипотребностей в технической помощи. В семинаре приняли участие представители 23 стран, осуществивших или осуществляющих переход или способных вскоре отказаться от внешнегофинансирования, представители гражданского общества и общественные организации,представители донорских и партнерских организаций, а также сотрудники Глобального фонда,штаб-квартиры ВОЗ и нескольких региональных бюро ВОЗ. В данном документе приводитсяобзор содержания семинара, обобщаются его результаты и конкретные действия.

Interregional workshop in preparation for transitioning towards domestic financing in TB, HIV and Malaria response: Tbilisi, Georgia, 17–19 October 2018: workshop report

An interregional workshop to prepare countries for transitioning to domestic financing in the tuberculosis, HIV and malaria response, organized jointly by the WHO Regional Office for Europe, WHO headquarters, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Agency for International Development, took place on 17–19 October 2018, in Tbilisi, Georgia. The overall objective was to provide a platform for countries and key partners to exchange good practices, lessons learned and common challenges in transitioning to domestic financing, and to define the next steps and technical assistance needs. Participants included representatives from 23 countries that have transitioned, are transitioning or may soon transition from external financing; representatives from civil society and community organizations; representatives from donor and partner organizations; and staff of the Global Fund, WHO headquarters, and several WHO regional offices. This document reviews the meeting content and summarizes outcomes and action points.