英语论文网

Indonesia, South Africa, Tanzania and Thailand [37], [38], [39]. Although there is little published research on economic support and treatment, improved uptake of HIV testing and treatment and improved treatment outcomes have been reported in respect of a number of social protection interventions, such as cash transfers [40], and food support [41].

Delayed, interrupted and incomplete treatment, in this case of both HIV and TB, not only poses a serious risk to individual health, but also increases the disease risk to others in the household and beyond [21]. Moreover, catastrophic cost of illness in itself increases vulnerability of household members. For poor households, a cost burden around 10% of annual income for medical care is calculated to lead to cuts in consumption, sale of assets, and debt that is likely to result in further impoverishment with the threat of destitution [39]. Household strategies to manage out-of-pocket medical costs threaten their future health and wellbeing. For example, diminished food intake, through subsequent malnutrition, can increase the risk of TB disease amongst those infected [42], [43].

WHO [44], UNAIDS [45], ILO [46] and others argue strongly that transfers and additional forms of social protection are essential to enable vulnerable people to protect themselves from infection, increase access to diagnosis and treatment, improve adherence to treatment, and prevent destitution. However, the extent of inclusion of such interventions in disease programmes, such as those for TB and HIV, is poorly documented. Several programs - including some financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria – are providing economic support in a variety of forms, from cash transfers for poverty alleviation to transport reimbursement and meals provided to enable and incentivise attendance at health facilities for care.

In this paper, we analyse Rounds 7 and 10 HIV and TB grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). We identify funded programs and describe the stated rationale for, and extent and nature of these efforts. For those with sufficient information, we calculate the number of individuals benefitting from economic support, the proportion of the total budget and the annual US$ per person benefit.

Two rounds of country Proposals to the Global Fund for HIV and TB grants approved by the Technical Review Panel for funding were examined to determine if they include economic support to address barriers to prevention, treatment and care and support. Proposals submitted for HIV and TB support in Round 10 (year 2010) provide an indication of recognition within country, in recent years, of the perceived importance of providing economic support to success of their disease programme, but do not indicate the actual amount allocated through grant negotiations to economic support, nor achieved expenditure in the first two years of the grant. For this reason, Round 7 TB and HIV grants (year 2007) were also examined to determine not only what was included in proposals, but also how much of the budget for economic support was spent at the end of the first phase of the grant. The emphasis in this analysis is on Round 10 (tables included), with Round 7 included for comparison (suggested to be included as web material).