Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34: a mathematical modelling study

Background: Children are at increased risk of developing and dying from tuberculosis. We aimed to estimate the additional paediatric tuberculosis deaths that could occur over 2025–34 if programmes supported by US bilateral health aid and The Global Fund to Fight AIDS, Tuberculosis, and Malaria are discontinued.

Methods: For this modelling study we collated data on funding sources for tuberculosis and HIV programmes in low-income and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models of tuberculosis and HIV for 130 countries, we projected the discontinuation of tuberculosis and HIV treatment services under several funding reduction scenarios, and how this would affect paediatric (ages 0–14 years) tuberculosis exposure and treatment access. We projected paediatric tuberculosis incidence and mortality over 2025–34 to calculate the impact of funding reductions.

Findings: Compared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid is projected to result in an additional 2·5 million (95% uncertainty interval [UI] 1·8–3·3) paediatric tuberculosis cases and 340 000 (240 000–460 000) tuberculosis deaths over 2025–34. Withdrawal of US support to The Global Fund and reductions in non-US contributions are projected to result in an additional 8·9 million (95% UI 6·9–11·5) paediatric tuberculosis cases and 1·5 million (1·1–2·0) tuberculosis deaths, more than double the number of paediatric tuberculosis deaths expected with continued service levels (1·10 million [0·89–1·38]). Impacts were greatest in the WHO African and South-East Asia regions. Restoration of services in 2026 was projected to lead to a substantially smaller number of additional deaths (39 000 [95% UI 29 000–51 000]).

Interpretation: Without actions to restore discontinued services, cuts to health aid for tuberculosis and HIV programmes could result in millions of additional childhood tuberculosis cases and deaths in low-income and middle-income countries over the next decade.

Funding: None.