Making the Case for Increased Investment in Tuberculosis Detection and Control in Cambodia

However, Cambodia remains a high-burden country, with the majority of TB funding coming from external sources, and about two in five patients experiencing TB-related costs that exceed 20 percent of their household income. CENAT has prioritized strategies such as scaling up active case finding and use of GeneXpert to overcome these challenges and reduce incidence by 80 percent from 2016 to 2030. To support CENAT, the Health Policy Plus (HP+) project, funded by the U.S. Agency for International Development, set out to answer key questions regarding TB control in Cambodia. The project defined four scenarios for analysis, including a base scenario that assumes constant coverage of TB services, a scale-up scenario that increases coverage of screening and preventive therapy, a diagnostic improvement scenario that improves diagnostic accuracy, and an ambitious scenario that assumes more aggressive screening to meet national TB targets. HP+ used the TB Impact Model and Estimates (TIME), an epidemiological transmission model, to estimate the number of people to receive TB services each year and the health impacts of scaling up TB prevention, detection, and treatment. Total resource requirements from 2019 to 2025 range from US$71 million for the base scenario to US$185 million for the ambitious scenario. Across all scenarios except for the base scenario, projected levels of funding are insufficient to cover TB-specific costs. For example, the country faces nearly a US$91 million funding gap from 2019 to 2025 under the most ambitious scenario. Meeting the ambitious scenario's targets would require an additional US$185 million from 2019 to 2025. Cambodia's TB burden remains significant, with a 13th highest incidence rate globally in 2017. The TB program faces financial and program challenges, including a reliance on external funding and catastrophic TB-related costs experienced by two in five patients. Filling the funding gap would avert an estimated 89,099 TB infections and 39,515 TB-related deaths from 2019 to 2025. Improved health outcomes would also decrease patient TB-related costs, with direct costs decreasing by US$20 million and indirect costs decreasing by US$40 million from 2019 to 2025 under the ambitious scenario.