HIV, TB and malaria programs saved health systems $135 billion in avoided visits

A modelling study published April 8 in PLOS Medicine puts a number on an argument that has mostly been made qualitatively: that decades of targeted spending on HIV, tuberculosis, and malaria did more than treat those three diseases. It kept sick people out of the general hospitals and clinics that donor programs were not designed to fund [s1].

The estimate — 6.9 billion outpatient visits and 3.9 billion inpatient bed-days averted between 2000 and 2023, worth an estimated $135 billion — is a counterfactual model, not a measurement of money that changed hands [s1]. It arrives as US and other donor governments debate cutting the disease-specific funding streams the study credits with producing that effect.

What the researchers did

A team led by researchers affiliated with Avenir Health and Imperial College London modelled primary healthcare utilization in 108 low- and middle-income countries under two scenarios: the actual scale-up of HIV, tuberculosis, and malaria (HTM) services that occurred between 2000 and 2023, and a counterfactual in which service coverage for all three diseases stayed frozen at year 2000 levels [s1].

The logic is straightforward. Someone with untreated HIV, active tuberculosis, or malaria who cannot access disease-specific care does not simply go without treatment — many end up in a general outpatient clinic or hospital bed, using primary healthcare capacity that was never budgeted for that purpose. By comparing the two scenarios, the researchers estimated how many outpatient visits and inpatient bed-days the scale-up of dedicated HTM services prevented from landing on the general health system, then applied published unit costs to convert that into a dollar figure [s1].

The numbers

Over the 23-year period, the model estimates that HTM scale-up averted 6.9 billion outpatient primary healthcare visits (95% uncertainty interval, 4.4 to 10.5 billion) and 3.9 billion inpatient bed-days (95% uncertainty interval, 2.5 to 5.9 billion), representing an estimated $135 billion in averted costs (95% uncertainty interval, $71 billion to $250 billion) [s1]. The width of those intervals is itself informative — the central estimate could plausibly be off by nearly half in either direction, a reflection of how much the underlying assumptions about care-seeking behavior and unit costs vary across 108 countries and two decades.

The effect was concentrated in sub-Saharan Africa and East Asia and the Pacific, the regions carrying the heaviest HIV, tuberculosis, and malaria burden [s1]. Expressed as a share of existing health system capacity, the averted utilization represented a median of 4.4% of hospital bed capacity and 1.6% of government health spending across all 108 countries in 2023 — but 22.9% of bed capacity and 5.1% of government health spending in low-income countries specifically [s1]. For the poorest health systems in the sample, in other words, the model implies that disease-specific HTM funding was doing the work of roughly a fifth of their hospital bed capacity.

What the study does not show

This is a modelled counterfactual, built on mathematical disease models and published unit costs, not a direct measurement of patients or spending. The authors note their analysis did not account for changes to primary healthcare services themselves beyond utilization, and that missing country-level data points were filled in using regression-based estimation rather than observed figures [s1]. The $135 billion figure describes averted costs to health systems over 23 years cumulatively — it is not an annual saving, and it says nothing about whether the same health outcomes could have been achieved more cheaply through a different funding architecture.

The study also does not model the reverse scenario directly: what would happen to primary healthcare utilization if HTM-specific funding were now reduced from current levels, as opposed to the historical counterfactual of funding never having scaled up at all. Extrapolating from the historical estimate to current funding debates requires an inference the paper itself does not make.

Why the timing matters

The paper does not reference current-year budget fights — its data run through 2023, and 2026 funding proposals are outside its scope. But it is being published into a specific moment: the same week that debates continue in Washington over an FY2027 budget request that would eliminate direct US funding to the World Health Organization and leave the Global Fund's future contribution unspecified.

The study's authors frame their findings as a case for considering PHC-system effects when evaluating HTM investment — a narrower and more technical claim than "cutting this funding would overwhelm hospitals," even if the two are easy to conflate in summary [s1]. Readers encountering the $135 billion figure in other coverage should treat it as a historical, model-based estimate of value already delivered, not a forecast of what withdrawal would cost going forward.

This article is informational and is not medical advice.

Sources

• [s1] Su JS, Stover J, Pretorius C, Winskill P, Sweeney S, Hallett TB, Menzies NA. "The benefits of investments to combat HIV, tuberculosis, and malaria for primary healthcare from 2000 to 2023: An economic modeling analysis." PLOS Medicine, 8 April 2026. https://doi.org/10.1371/journal.pmed.1005036