Tuberculosis (TB) remains one of the world’s leading public health challenges, with an estimated 10.7 million people affected and 1.23 million deaths reported in 2024. The COVID-19 pandemic significantly disrupted TB services, causing notifications to fall from 7.1 million in 2019 to 5.8 million in 2020. These disruptions led to a surge in undiagnosed and untreated TB cases, increasing transmission and mortality. Encouragingly, global TB notifications rebounded in 2024, reaching a record 8.3 million cases, indicating a recovery in case detection and service delivery.
Over the past two decades, the Global Fund has played a major role in strengthening the global response to HIV, TB, and malaria, helping save approximately 70 million lives. Through investments exceeding $11 billion in TB programs across low- and middle-income countries, the Global Fund has contributed to a 40% reduction in TB mortality. Its support has enabled the adoption of innovative technologies such as artificial intelligence–enabled digital chest X-rays, rapid molecular diagnostics, and shorter, more patient-friendly treatment regimens. In 2024 alone, more than 7.4 million people received TB treatment, including 120,000 individuals with drug-resistant TB, while 5.6 million people benefited from TB preventive treatment.
Despite this progress, the global TB response continues to face significant financial challenges. Achieving the global goal of ending TB by 2030 requires investments of $22 billion by 2027 and $35 billion by 2030, as pledged during the 2023 United Nations High-Level Meeting. However, only $5.9 billion—approximately 27% of the required funding—was available in 2024. Funding cuts and reduced donor support have further disrupted TB programs, particularly in low- and middle-income countries. In this context, improving program efficiency and maximizing available resources are essential to sustaining progress.
A recent study examined how evidence-based and cost-effective interventions could optimize TB programs under financial constraints. Using a mixed-methods approach, the study combined a literature review covering publications from 2019 to 2024 with key informant interviews involving six experts from international TB organizations, academic institutions, national TB programs, ministries of health, and non-governmental organizations. The analysis focused on structural, institutional, and individual factors that influence program efficiency and sustainability.
The findings identified several scalable strategies that can enhance TB program efficiency while addressing funding gaps. One major approach involves integrating TB services within existing health programs. Community-based outreach models that combine contact investigation, diagnosis, treatment, and preventive therapy during a single household visit have proven effective in reducing costs and improving case detection. Community health workers play a critical role in this approach by screening household members, tracing patients lost to follow-up, collecting sputum samples, and facilitating access to treatment and preventive care.
Innovations in TB screening and diagnosis also offer significant opportunities for efficiency gains. Combining chest X-rays, computer-aided detection powered by artificial intelligence, and rapid molecular tests such as Xpert MTB/RIF in mobile outreach programs can improve detection rates and reduce diagnostic delays. In several countries, targeted screening using mobile diagnostic units has successfully identified TB cases among high-risk populations. Artificial intelligence tools can further enhance accuracy while reducing costs, particularly in high-volume screening settings.
Diagnostic optimization strategies such as sputum pooling and the use of portable molecular testing platforms can expand testing capacity while conserving limited resources. In addition, decentralized diagnostic technologies such as TrueNat and stool-based testing have shown promise in improving TB diagnosis among children and in remote areas.
Improving treatment efficiency is another key strategy. Decentralizing drug-resistant TB services and adopting shorter treatment regimens can significantly reduce costs while improving patient outcomes. For example, shorter preventive treatment regimens and new six-month drug-resistant TB treatments have demonstrated substantial savings and higher treatment completion rates. Integrating these regimens into routine TB care can help health systems deliver more efficient and patient-centered services.
Strengthening the health workforce, particularly through community health workers, also enhances program effectiveness. Evidence from multiple countries shows that community-based approaches can detect cases earlier, improve treatment adherence, and reduce stigma associated with TB. Digital learning platforms and online training programs for health workers have also emerged as cost-effective alternatives to traditional in-person training, allowing programs to expand capacity while reducing operational costs.
Engaging the private sector is another important strategy for expanding access to TB services. Many patients initially seek care from private providers, making their involvement essential for early diagnosis and treatment. Innovative public–private partnership models have improved access to affordable TB testing and treatment while strengthening case notification and treatment adherence. These collaborations leverage existing healthcare infrastructure and help reduce diagnostic gaps.
Integrating TB services into broader health systems further improves efficiency and patient outcomes. Programs that combine TB services with HIV care, diabetes management, maternal and child health services, and nutrition programs can increase case detection and streamline service delivery. Shared specimen transport networks and integrated diagnostic systems also reduce duplication and improve coordination across disease programs.
The study also highlighted the importance of governance, stakeholder engagement, and innovative financing mechanisms. Community-driven interventions, private sector partnerships, and strong collaboration with local institutions can enhance program sustainability. At the same time, increasing domestic investment, expanding health insurance coverage, and exploring innovative financing mechanisms such as performance-based financing, blended financing, and debt swaps can help close funding gaps.
Overall, the findings suggest that optimizing TB programs requires a combination of integration, innovation, and multisectoral collaboration. Efficiency gains alone cannot replace the need for sustained funding, but they can help maximize available resources and strengthen health systems. With continued commitment, investment, and adaptation of proven strategies, countries can protect recent gains and move closer to the global goal of ending TB.
