COVID-19 has brought a lot of pressure to her life. …

September 2021

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Contents

Results Report 2021 Contents

04

Letter from the Executive Director

31

Tuberculosis: State of the Fight

70

Investing for Impact

97

Note on Methodology

Cover photo by Ed Wray

10

Key Results and Lives Saved

45

Malaria: State of the Fight

80

Fighting COVID-19

15

HIV: State of the Fight

58

Resilient and Sustainable Systems for Health

89

20 Years of Impact: How We Changed the Story

Online Report

For an interactive version of this report, visit:

. org/en/results/

For 23-year-old Daoprakri Deepal, a nursery school teacher in Bangkok, COVID-19 has brought a lot of pressure to her life. "There is a big change because my husband became unemployed and we lost the main income for the family. I'm worried about a lot of things ?the family is struggling." ? UNICEF/Patrick Brown

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Results Report 2021 Letter from the Executive Director

Letter from the Executive Director

Results Report 2021 Letter from the Executive Director

05

2021 marks the Global Fund's 20th anniversary. In those two decades, we have made remarkable progress against HIV, TB and malaria. But as we celebrate this milestone, we face a new and sobering reality: COVID-19 is reversing many hard-fought gains in the fight against these diseases.

To mark our 20th anniversary, we had hoped to focus this year's Results Report on the extraordinary stories of courage and resilience that made possible the progress we have achieved against HIV, TB and malaria over the last two decades, celebrating the countless heroes across the Global Fund partnership who have worked so hard and given so much to beat back the three epidemics. But the 2020 numbers force a different focus. The impact of COVID-19 on the fight against HIV, TB and malaria and the communities we support has been devastating. For the first time in the history of the Global Fund, key programmatic results have gone backwards.

On the cover of this year's report, there is a photo of a young woman, An Biya Nur Melani, who fought and won a terrifying battle against multidrug-resistant TB (MDR-TB) eight years ago, when she was just 17. An Biya was able to access the medicines to fight the disease, after the Global Fund support for treatment of drug-resistant TB arrived in Indonesia in 2009. She was one of the lucky ones: only 38% of people with drug-resistant TB access care. And even for those who access care, only 57% are successfully treated. The rest do not finish their treatment, or the treatment doesn't work for them ? and they die. An Biya endured 18 months of daily trips to the health clinic for the intensive treatment required to cure her of MDR-TB. But one can't help but wonder: if An Biya caught MDR-TB today in Indonesia ? a country currently facing

its biggest wave of COVID-19 to date, with health systems under acute stress and with hundreds of people dying every day from the virus ? would she have been tested for MDR-TB? Would she have been able to undergo the intensive and protracted treatment necessary to save her life? Would she have been able to access the support needed to beat drug-resistant TB?

The impact of the COVID-19 pandemic on the fight against TB worldwide has been devastating. Between 2019 and 2020, the number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by a staggering 19%, with those on treatment for extensively drug-resistant TB registering an even bigger drop of 37%, the number of HIV-positive TB patients on antiretroviral treatment as well as TB treatment dropped by 16%. Overall, around one million fewer people with TB were treated in 2020 compared with 2019.

The impact of COVID-19 on the fight against HIV has also been significant. While it is encouraging that the number of HIV-positive people receiving antiretroviral treatment has continued to increase ? by 9% ? the declines in prevention services and testing are alarming. Compared with 2019, people reached with HIV prevention programs and services declined by 11% while young people reached with prevention services declined by 12%. Medical male circumcision for HIV prevention declined by 27%. HIV tests taken declined by 22%.

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