Results Report 2021

In 2021, the Global Fund celebrates 20 years since we were founded. During that time, we have made remarkable progress against HIV, TB and malaria. But over the last year, the impact of the COVID-19 pandemic has been devastating. For the first time in the Global Fund’s history, key HIV, TB and malaria programmatic results declined.

The Global Fund’s Results Report 2021 details how our partnership moved swiftly to support countries to respond to the COVID-19 pandemic and to adapt lifesaving HIV, TB and malaria programs so they could safely continue. In more than 120 countries and regions around the world, we are also making urgent reinforcements to systems for health needed to defeat today’s pandemics and prepare for tomorrow’s.

Key Results and Lives Saved

Health programs supported by the Global Fund partnership had saved 44 million lives as of the end of 2020. Overall, the number of deaths caused by AIDS, TB and malaria each year have been reduced by 46% since 2002 in countries where the Global Fund invests.

44 million lives saved

Key Results

21.9m

People on antiretroviral therapy for HIV in 2020

4.7m

People with TB treated in 2020

188m

Mosquito nets distributed in 2020

Programmatic results achieved during 2020 by countries and regions where the Global Fund invests.

The coverage of treatment and prevention interventions for HIV, TB and malaria in countries where the Global Fund invests has grown since we were created in 2002. However, malaria prevention progress has slowed in recent years. We also don’t yet know the full impact of the COVID-19 pandemic on HIV, TB and malaria treatment and prevention coverage.

Coverage of treatment and prevention interventions

Select:

HIV - % of people living with HIV on antiretroviral therapy
Tuberculosis - % of TB treatment coverage
Malaria - % of population with access to a long-lasting insecticide-treated net
Malaria coverage calculated based on 38 African countries for which data is available from WHO / Malaria Atlas Project estimates in countries where the Global Fund invests. HIV and TB estimates are based on all countries where the Global Fund invests. Based on data from WHO (2020 release for TB and malaria) and UNAIDS (2021 release).

We measure our progress against the targets in the global plans for HIV, tuberculosis and malaria and in Sustainable Development Goal 3: Health and well-being for all.

Health worker greets a child in her community, Rwanda.

That achievement is the result of efforts by a wide array of actors comprising the Global Fund partnership, including governments, multilateral agencies, bilateral partners, civil society groups, people affected by the diseases, and the private sector.

These numbers are stark confirmation of what we feared might happen when COVID-19 struck. In many countries, COVID-19 has overwhelmed health systems, lockdowns have disrupted service provisions, and critical resources have been diverted from the fight against HIV, TB and malaria to fight the new pandemic.
Peter Sands, Executive Director of the Global Fund
A woman gets tested for HIV, South Sudan.

HIV: State of the Fight

Key HIV results for 2020 in countries where the Global Fund invests:

21.9m

People on antiretroviral therapy for HIV – an 8.8% increase compared to 2019 despite COVID-19.

104m

People tested for HIV – a 22% decrease compared to 2019 due to COVID-19.

8.7m

People reached with HIV prevention services – an 11% decrease from 2019 due to COVID-19.

Together with PEPFAR and other partners, our efforts to implement WHO’s “treat all” guidance and the UNAIDS “90-90-90” strategy have significantly increased the number of people living with HIV who know their HIV status, the number of people on antiretroviral therapy and the number of people on antiretroviral therapy who have viral suppression.

People living with HIV who know their status

ARV coverage

People living with HIV with suppressed viral load

Progress graphs are based on latest published data from UNAIDS, 2021 release.
A transgender woman preps an HIV self-test, Guatemala.
Bryanna, a transgender woman, preps an HIV self-testing kit at home.

The Global Fund is supporting countries to adapt HIV services to counter the impact of COVID-19, including multimonth dispensing of antiretroviral drugs to ensure continued treatment; multimonth dispensing of HIV prevention supplies such as condoms, lubricants, needles, syringes and PrEP; and providing prevention and outreach services via digital platforms and social media. But the impact of COVID-19 was severe. Key prevention and testing services declined by 11% and 22% respectively compared to the previous year.

HIV infections among women aged 15 to 24

Adolescent girls and young women remain a key focus for Global Fund’s response to HIV. We have significantly increased our investments, focusing on the 13 priority countries where HIV burden is highest. In these countries, new HIV infections among adolescent girls and young women have dropped by 41% since 2010 in the 13 priority countries. A drop in new HIV infections among young women and girls aged 15-24 was recorded by all countries except for Zambia, which saw a rise in the new infections between 2010 to 2020. However, even for Zambia, that rise can largely be accounted for by the increase in population among youth 15-24 years, as the incidence rate among young women and girls in this group continued to decline.

New HIV infections among women age 15 to 24

% change 2010-2020, in 13 priority countries
Bubble size represents new HIV infections, 2020
HIV burden estimates from UNAIDS, 2021 release.

HIV trends in deaths and infections

In countries where the Global Fund invests, AIDS-related deaths have been reduced by 65% and new infections have been reduced by 54% since 2002. Eight countries have surpassed the UNAIDS “90-90-90” 2020 testing and treatment targets; however, most countries missed this target. As the COVID-19 pandemic continues, it is unclear if the decrease in testing and prevention services in 2020 will lead to increased deaths and infections.

Select:

With prevention and ARVs (actual)
If there had been no prevention or ARVs

Trends in AIDS-related deaths

Trends in new HIV infections

HIV burden estimates from UNAIDS, 2021 release. Estimation of “no prevention or ARVs” trends from Goals, AEM and AIM models. Global Fund portfolio indicates countries where the Global Fund invests. Impact is assumed to be zero if the actual estimates exceed the counterfactual.
A health worker offers HIV counseling, Djibouti.
A health worker offers HIV counseling and testing to people living in Djibouti City, Djibouti.

Investing for impact

The Global Fund provides 25% of all international financing for HIV programs (10% of available resources) and has invested US$22.7 billion in programs to prevent and treat HIV and AIDS and US$3.8 billion in TB/HIV programs as of June 2021. Since 2020, the Global Fund has provided additional funding through the COVID-19 Response Mechanism to countries to mitigate the impact of COVID-19 on the HIV response.

Select:

People living with HIV who know their status

People living with HIV receiving ARVs

People living with HIV with suppressed viral load

Prevention of mother-to-child transmission coverage

HIV investment - Global Fund (2002-2021)

All data is based on mid-point estimates from UNAIDS 2021 release, other than Global Fund disbursements which are available on the Global Fund Data Explorer. Detailed notes on investment and impactdownload in English | Français ] .

Over the 20 years of the existence of the Global Fund partnership, the world has made extraordinary progress in the fight against HIV. To continue that momentum and regain lost ground due to COVID-19, we must scale up and expand successful programs to prevent, test and treat HIV.

A doctor shows an x-ray photo to a TB patient.

Tuberculosis:
State of the Fight

Key TB results in 2020 in countries where the Global Fund invests:

4.7m

People treated for TB – an 18% decrease compared to 2019 due to COVID-19.

101,000

People on treatment for drug-resistant TB – a 19% decrease compared to 2019 due to COVID-19.

194,000

Children in contact with TB patients received preventative therapy – a 13% increase compared to 2019 despite COVID-19.

271,000

HIV-positive TB patients on antiretroviral therapy during TB treatment in 2020 – a 16% decrease compared to 2019 due to COVID-19.

The Global Fund is working with the Stop TB Partnership and WHO to find more “missing” people with TB – people who go undiagnosed, untreated and unreported, and could die or continue to spread the disease to others without treatment. Over one million additional cases were notified by the end of 2019.

TB treatment coverage

TB treatment success rate (all forms)

ARV coverage among HIV+ TB patients

Progress graphs are based on latest published data from WHO, 2020 release.
Lab worker at a hospital in Mumbai.
A lab technician conducts a test for COVID-19 at Nair hospital in Mumbai, India.

While COVID-19 surpassed TB as the world’s leading infectious disease killer in 2020, TB – another airborne disease that was once a global pandemic – remains the second biggest, with more than 1.4 million people dying of the disease in 2019 (including HIV-positive people).

TB trends in deaths and cases

In countries where the Global Fund invests, TB deaths (excluding HIV-positive deaths) since the Global Fund was founded in 2002 have been reduced by 28%. But as the COVID-19 pandemic continues, it is unclear if the decrease in testing and treatment services in 2020 will lead to increased deaths and infections.

Select:

With TB control (actual)
If there had been no TB control

Trends in TB deaths (excluding HIV-positive)

Trends in new TB cases (all forms)

TB burden estimates from WHO Global TB Report 2020. Estimation of “no TB control” trends for TB deaths from WHO and for new TB cases based on the assumption of constant trend in new TB cases since 2000. While major control efforts for malaria and HIV began with the launch of the Millennium Development Goals in 2000, TB control efforts began much earlier. The counter-factual and actual results therefore diverged from each other much earlier, making this graph look considerably different than its HIV and malaria counterparts. Global Fund portfolio indicates countries where the Global Fund invests. Impact is assumed to be zero if the actual estimates exceed the counterfactual.

Investing for impact

The Global Fund provides 77% of all international financing for TB (12% of total available resources) and has invested US$7.8 billion in programs to prevent and treat TB as of June 2021. Since 2020, the Global Fund has provided additional funding through the COVID-19 Response Mechanism to countries to mitigate the impact of COVID-19 on the TB response.

Select:

TB treatment coverage

TB treatment success rate

MDR-TB treatment success rate

HIV+ TB patients on ARVs

TB investment - Global Fund (2002-2021)

All data is based on mid-point estimates from Global Tuberculosis Report 2020, other than Global Fund disbursements which are available on the Global Fund Data Explorer. Detailed notes on investment and impactdownload in English | Français ] .
Cured TB patient turned community health worker.
Aftab Ansari spent years fighting for his life after being diagnosed with extensively drug-resistant tuberculosis. Eventually, through hope and sheer determination, he fully recovered. But today he may be facing an even bigger challenge: helping others survive the same disease he once overcame – in the middle of the COVID-19 pandemic.

To end both COVID-19 and TB as epidemics, we must fight both diseases at the same time, increasing investments in the same tools, health workers and systems for health needed to fight TB and COVID-19 and prepare for future airborne pandemics.

Mother with child under a mosquito net.

Malaria:
State of the Fight

Key malaria results in 2020 in countries where the Global Fund invests:

188m

Mosquito nets distributed to protect families from malaria – a 17% increase compared to 2019 despite COVID-19.

259m

People were tested for malaria – a 4.3% decrease compared to 2019 due to COVID-19.

11.5m

Pregnant women received preventive therapy – nearly the same as in 2019.

9.4m

Structures covered by indoor residual spraying in 2020 , a 2.9% increase compared to 2019 despite COVID-19.

Through leveraging economies of scale, working with partners and negotiating directly with manufacturers, we reduced the cost of an insecticide-treated mosquito net by 36% and the average cost of artemisinin-based combination (ACT) therapies by 39% between 2014 and 2020. Savings generated through the reduction in treatment costs alone enabled us to provide more than 59.8 million additional antimalarial treatments.

Mosquito nets population coverage

Mosquito nets population use

Suspected malaria cases tested

Progress graphs are based on latest published data from WHO, 2020 release. Malaria coverage calculated based on 38 African countries for which data is available from WHO / Malaria Atlas Project estimates.
Village malaria worker with malaria patient, Lao PDR.
Bon Pheng Phomphakdee, a village malaria worker and Katai, a malaria patient, in Songpeuay village, Lao PDR. Case detection is a major obstacle on the path to malaria elimination. Malaria volunteers, like Bon Pheng Phomphakdee, who bring health services to people’s homes, are the vanguard of Lao PDR’s malaria elimination efforts.

Great progress was made in malaria control between 2000 and 2017, with a reduction in overall cases and deaths, but that momentum has stalled. COVID-19 has exacerbated that challenge, knocking us further off track.

Malaria trends in deaths and cases

Since 2010, the highest malaria burden countries have achieved significant declines in the overall number of deaths as well as in driving down incidence rates. In countries where the Global Fund invests, malaria deaths have reduced by 45% between 2002 and 2019 (latest available data).

Select:

With malaria control (actual)
If there had been no malaria control

Trends in malaria deaths

Trends in malaria cases

Malaria burden estimates and estimation of “no malaria control” from WHO Global Malaria Program, 2020 release. Global Fund portfolio indicates countries where the Global Fund invests. Impact is assumed to be zero if the actual estimates exceed the counterfactual.

Investing for impact

The Global Fund provides 56% of all international financing for malaria programs (39% of total available resources) and has invested more than US$14.7 billion in malaria control programs as of June 2021. Since 2020, the Global Fund has provided additional funding through the COVID-19 Response Mechanism to countries to mitigate the impact of COVID-19 on the malaria response.

Select:

People with access to long-lasting insecticidal nets

People using long-lasting insecticidal nets

People with suspected malaria receiving diagnostic test

Malaria investment - Global Fund, 2002-2021

All data is based on mid-point estimates from World Malaria Report 2020, other than Global Fund disbursements which are available on the Global Fund Data Explorer. Detailed notes on investment and impactdownload in English | Français ] .
Malaria awareness march, Ghana.
Malaria health volunteer Agartha Effah (holding placard) participates in a march through Agogo town, Ghana, to help educate citizens on malaria and its prevention.

Despite the challenges brought about by COVID-19, the pandemic has produced a wave of innovations and adaptations to continue the fight against malaria. The certification of El Salvador as malaria-free in February 2021 shows that the target of eliminating malaria is still within reach – but we must work even harder to regain lost progress and adapt to the disruption caused by the COVID-19 pandemic.

Community health workers in PPE, India

Resilient and Sustainable Systems for Health

Resilient and sustainable systems for health are the foundation for defeating today’s infectious diseases and the basis for preventing, preparing for and responding to future pandemics. The Global Fund is the largest multilateral investor in grants for systems for health, investing more than US$1 billion a year to strengthen and build diagnostic tools and laboratory facilities; data and surveillance systems; procurement and supply chains; community systems and responses; and training of health workers. Learn more

Fighting COVID-19

The Global Fund responded swiftly to COVID-19, providing significant funding and leveraging our expertise and strong global networks. As of August 2021, we had approved US$3.3 billion to 107 countries and 16 multicountry programs through our COVID-19 Response Mechanism to support country responses to COVID-19 with critical tests, treatments and medical supplies, protect front-line health workers, adapt lifesaving HIV, TB and malaria programs, and reinforce fragile systems for health. Learn more

Investing for Impact

The Global Fund is a proven and effective vehicle to channel investments to respond to the world’s deadliest infectious diseases and prepare for future pandemics in low- and middle-income countries. In 2020 alone, the Global Fund disbursed US$4.2 billion to support countries to fight HIV, TB and malaria and strengthen systems for health and approved an additional US$980 million in funding to respond to COVID-19, mitigate the impact of COVID-19 on lifesaving HIV, TB and malaria programs and make urgent improvements to health and community systems.

Our Results Methodology

The Global Fund’s programmatic results and impact are calculated using the data for HIV, TB and malaria in countries where we invest in a given year. The Global Fund uses the official disease burden and impact estimates developed and published by our technical partners, including WHO and UNAIDS, as the basis for measuring impact. Learn more

Results Report 2021

Our Results Report 2021 delivers a summary of the results achieved through the end of 2020 in countries where the Global Fund invests.

Full report
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Summary
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Annex
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