Global Fund explains “Transitional Funding Mechanism” — No funding for HIV treatment scale up

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The Global Fund to Fight AIDS, Tuberculosis and Malaria released an “Information Note” explaining the Transitional Funding Mechanism (TFM) that the Fund Board recently decided would replace a Round 11 funding cycle. The information note and accompanying documentation are meant to aid applicants in the development of proposals for TFM funding.

Transitional Funding Mechanism timelines from page 7 of the Informational Note.

According to the Fund, the TFM aims to secure funding for the continuation of grants for programs that face disruption of essential prevention, treatment and/or care services currently supported by the Global Fund and for which no alternative sources of funding can be secured. To apply for TFM funding, the disruption (for example, the end date of an existing grant) must fall between Jan. 1, 2012 and March 31, 2014, and the maximum proposal term must not exceed two years.

“The Global Fund will support continuation of early diagnosis/detection where it is deemed an essential component of disease programs,” according to the report, with the caveat that early diagnosis could result in increases in the number of people requiring treatment.  Alternate sources of funding must be identified for addressing this increase to cover the costs of placing additional people on treatment, the report continues, as the “TFM will not support scale up beyond current levels of reach.”

To that end, the document details the requests it will most likely continue to issue support “at the existing scale.” Existing scale restricts the potential funding to the “same number of patients receiving a service at time of imminent disruption, in the same geographical area, in the same target population and with a similar or lower budget.” This includes interventions whose interruption would mean a significant rebound in transmission, save lives, are high impact, evidence-based, targeted to the most appropriate populations, and represent good value for money in a resource-constrained environment. Specific examples of interventions likely to be approved were antiretroviral therapy (ART), TB screening and treatment among people living with HIV/AIDS, male circumcision (MC) in settings with high HIV prevalence and low rates of MC, and evidence-based prevention and treatment programs targeted at high incidence populations, such men who have sex with men, injection drug users and sex workers.  

The document makes clear that new interventions or those that aim to scale up services, including essential interventions, beyond what will be reached when funding is disrupted will not be supported. Nor will interventions that are not high impact, have not been evaluated and demonstrated to be effective, are not targeted to appropriate populations, and/or do not demonstrate adequate value for money in a resource-constrained environment. Notably, scale up of antiretroviral therapy would not be permitted.

The document also excludes several tuberculosis interventions, including the scale up of directly observed treatment short course (DOTS) and the scale up of drug-susceptible and multidrug-resistant TB services, from the “supported” list.  The information note does not explicitly state that the existing scale of these services will be maintained without disruption.

From Page 2 of the Eligibility, Counterpart Financing and Prioritization Information Note.

“G20 upper-middle income countries with less than an extreme disease burden are not eligible to apply,” according to the document. Should funding run short in the TFM, the Board will guide a prioritization process that takes into account: the disease burden and country income level of applicants (see chart) as a relative indicator of country need; the prioritization of proposals within the “Targeted Pool” (a term the document does not define) by the Technical Review Panel; and the objective of avoiding disruption of essential services.