Komatsu et al. BMC Infectious Diseases 2010, 10:109 http://www.biomedcentral.com/1471-2334/10/109 Open Access RESEARCH ARTICLE BioMed Central © 2010 Komatsu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research article Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007 Ryuichi Komatsu* 1 , Eline L Korenromp 1 , Daniel Low-Beer 1 , Catherine Watt 2 , Christopher Dye 2 , Richard W Steketee 3 , Bernard L Nahlen 4 , Rob Lyerla 5 , Jesus M Garcia-Calleja 6 , John Cutler 1,7 and Bernhard Schwartländer 8,1 Abstract Background: Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund. Methods: Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models. Results: By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented. Conclusions: These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems. Background Only in some five years, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has become a major player in international health development. In 2005, the Global Fund provided 21% of international funding for HIV/AIDS programs in low- and middle- income countries, 67% for tuberculosis (TB), and 64% for malaria[1]. By December 2007, it has approved a total of US$ 10.1 billion proposals, in more than 550 grants in 136 countries, of which US$ 4.8 billion had been dis- bursed to recipients in 134 countries[2]. As control effort of the three diseases is scaled up, there is now consider- able interest to show the scale of health benefits from interventions supported. For evaluation of disease impact, Global Fund recipi- ents collect epidemiological data on relevant changes in mortality and morbidity. Given the nature of the diseases and interventions and data collection mechanisms, it may take several years before impact becomes detectable. For example, reductions in new HIV infections are inferred retrospectively from prevalence trends over preceding years. WHO and UNAIDS regularly publish regional- level HIV incidence and prevalence estimates, using country surveillance and survey data that often require * Correspondence: ryuichi.komatsu@theglobalfund.org 1 The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin Blandonnet 8, 1214 Vernier, Geneva, Switzerland Full list of author information is available at the end of the article