Abstract
The recent withdrawal of U.S. financial support threatens essential TB service delivery, including diagnostics, treatment, TB-HIV co-infection interventions and research initiatives critical to eradicating TB. This study analyses the dependency of and potential impact of funding cuts to 26 high-burden TB countries (HBCs). We modelled three recovery scenarios: (1) minimal impact (services recover within three months), (2) moderate impact (recovery within one year), and (3) worst-case scenario (long-term service reduction). Extrapolations were made for all 26 HBCs based on representative countries from each dependency category. Across all 26 HBCs, additional TB cases between 2025 and 2030 are estimated at 0.63 million (CI 0.45-0.81) (minimal impact), 1.66 million (CI 1.2-2.1) (moderate impact), and 10.67 million (CI 7.85-13.19) (worst-case). Corresponding TB deaths are projected to increase by 99,900 (CI 65,200-130,000), 268,600 (CI 185,800-337,900), and 2,243,700 (CI 1,570,800-2,807,300), respectively. The loss of U.S. funding endangers global TB control efforts, jeopardizing progress towards End TB and SDG targets, and potentially puts millions of lives at risk. While some nations may adapt, short-term disruptions will severely impact vulnerable populations. Urgent alternative funding is needed to sustain critical TB prevention and treatment efforts.