近日，瑞士全球抗击艾滋病基金会Johannes Hunger团队研究了抗击艾滋病毒、结核病和疟疾的最佳投资案例：一项全球建模研究。2025年7月3日出版的《柳叶刀》杂志发表了这项成果。

可持续发展目标包括到2030年终结艾滋病毒、结核病和疟疾的流行。实现这一目标还有5年的时间，全球防治艾滋病、结核病和疟疾基金正在为2027-29年的方案寻求资金，因此，确定通过继续投资防治这些疾病可以取得的成果至关重要。该研究组的目的是通过分析这三种疾病的供资情况和流行病学情况、关键方案的成本以及有资格获得全球基金支助的国家今后可能取得的进展程度，来估计潜在的影响。

在这项建模研究中，研究组根据联合国艾滋病规划署、控制结核病伙伴关系和世卫组织制定的全球计划，对全球基金支持的国家抗击艾滋病毒、结核病和疟疾所需的财政资源进行了估计。对未来几年可用资源的估计是这样得出的：假定防治这三种疾病的国家支出将与政府一般支出同步增长，全球基金将额外捐助180亿美元，其他发展援助的实际水平与2020 - 2022年期间的平均水平相同。对这三种疾病中的每一种都使用了流行病学模型和成本计算模型，以量化对符合全球基金资格的国家可能产生的影响（包括对总死亡率和发病率的影响）。投资回报率（ROI）的计算考虑了健康的内在价值和降低发病率和过早死亡风险的直接经济效益。这项分析是在2024年底完成的，使用的是2023年的最新数据。预测期的重点是2027 - 2029年，在这一时期，扩大计划和资金尚未承诺，全球基金第八次增资筹集的大部分资源将在这一时期使用。

据估计，2027 - 2029年这三种疾病的总资源需求为1460亿美元。研究组计算出，其中1130亿美元（79%）的需求可以通过国内融资（697亿美元）、全球基金（180亿美元）和其他外部捐助者（236亿美元）来满足。对这些现有资源的最佳利用可在2027 - 2029年期间挽救2300万人的生命，避免4亿例病例和新感染。合并后的所有疾病死亡率的轨迹投影方法，需要达到2030年的西班牙(2030年与目标之间的差异之间的投影在2029年底1.5%和15.5%的正常聚合死亡率)，国与国之间的不平等在预期寿命将会在2029年下降7%，2027-29年，住院天数将减少1.89亿天，门诊次数将减少5.72亿次，节省11亿美元。每投入1美元，可创造高达19美元的内在健康价值或3.5美元的直接经济效益。

研究结果表明，继续投资防治艾滋病毒、结核病和疟疾，可产生巨大的健康收益和高投资回报。要实现这些惠益，就需要继续增加国家支出，并广泛维持针对这些疾病的外部融资，包括在2025年成功补充全球基金。

附：英文原文

Title: The case for optimal investment in combating HIV, tuberculosis, and malaria: a global modelling study

Author: Timothy B Hallett, Nicolas A Menzies, Stephen Resch, Carel Pretorius, John Stover, Jiaying Stephanie Su, Peter Winskill, Matt Gordon, Richard Grahn, Firdaus Mahmood, Mikaela Smit, Mehran Hosseini, Johannes Hunger

Issue&Volume: 2025-07-03

Abstract:

Background

The Sustainable Development Goals (SDGs) include ending the epidemics of HIV, tuberculosis, and malaria by 2030. With 5 years remaining to meet this goal, and with the Global Fund to Fight AIDS, Tuberculosis and Malaria seeking funding for programmes in 2027–29, establishing what can be achieved through continued investment in combatting these diseases is crucial. We aimed to estimate the potential for impact by analysing the funding landscape and epidemiological situations of these three diseases, the costs of key programmes, and the extent of possible future progress in the countries eligible for Global Fund support.

Method

In this modelling study, we developed estimates of the financial resources needed in Global Fund-supported countries to combat HIV, tuberculosis, and malaria from the global plans produced by UNAIDS, the Stop TB Partnership, and WHO. Estimates of available resources in the coming years were obtained by assuming that national expenditure on the three diseases would grow in line with general governmental expenditures, that the Global Fund would contribute an additional $18·0 billion, and that other developmental assistance would be at the same level in real terms as the average in the period 2020–22. Epidemiological and costing models for each of the three diseases were used to quantify the possible impact in Global Fund-eligible countries (including on aggregated mortality and incidence rates). The return on investment (ROI) was computed considering both the intrinsic value of health and the direct economic benefits of the reduced risk of morbidity and premature mortality. The analysis was completed at the end of 2024 with the latest available data, which pertained to the year 2023. The focus of the projection period was 2027–29, a period for which scale-up plans and funding have not yet been committed and the period when most of the resources raised by the eighth replenishment of the Global Fund would be used.

Findings

The total resource needs for the three diseases were estimated to be US$140·6 billion in 2027–29. We calculated that $111·3 billion (79%) of this need could be met from domestic financing ($69·7 billion), the Global Fund ($18·0 billion), and other external donors ($23·6 billion). Optimal use of these available resources could save 23 million lives and avert 400 million cases and new infections during 2027–29. The trajectory of the combined mortality rate for all diseases was projected to approach that needed to reach the SDG for 2030 (with a difference between the target in 2030 and the projection at the end of 2029 of between 1·5% and 15·5% of the normalised aggregated mortality rate), inequality in life expectancy between countries would be 7% lower by 2029, and 189 million fewer hospital days and 572 million fewer outpatient visits would be needed in 2027–29, saving $1·1 billion. For every $1·00 invested, there could be up to $19·00 in intrinsic health value created or $3·50 in direct economic benefits.

Interpretation

Continued investments to combat HIV, tuberculosis, and malaria could yield enormous health gains and a high return on investment. Realising these benefits will require continued growth in national expenditure and a broad maintenance of external financing for these diseases, including a successful replenishment of the Global Fund in 2025.

DOI: 10.1016/S0140-6736(25)00831-1

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00831-1/abstract