Impact of US funding cuts and stop work orders on TB services and research in South Africa

Over the past decade, South Africa has made great strides and reduced the incidence of TB by 57%.¹ This inspiring reduction was driven by improved TB testing and treatment and the scale-up of antiretroviral treatment supporting virological control in people living with HIV (PLHIV). TB services and research in South Africa have been heavily impacted by recent US funding cuts. South Africa’s high TB burden and established service and research infrastructure have attracted significant US investments. The efforts to curb TB and TB-HIV co-infection were the result of carefully constructed partnerships between the National TB Programme (NTP), provincial health departments and development partners such as The President’s Emergency Plan for AIDS Relief (PEPFAR), the US Centers for Disease Control and Prevention (CDC), The Global Fund, the Bill & Melinda Gates Foundation and, not least, the US Agency for International Development (USAID). In recent weeks, the US government first paused, then terminated foreign assistance through USAID. Though lacking the same finality, CDC support has also been largely affected. Uncertainty about future support poses a serious threat to sustaining these efforts beyond a mere reduction in funding. South Africa has one of the highest global burdens of TB, TB-HIV, and multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB), with an estimated TB incidence of 427 per 100,000 population (range 265–626).¹ In 2023, 270,000 new TB diagnoses were reported, more than half among PLHIV, and MDR/RR-TB incidence was estimated at 13,000.

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