Introduction
The suspension of US Government funding, particularly through USAID, has significantly disrupted tuberculosis (TB) response efforts in several high TB burden countries. Stop TB Partnership conducted a rapid assessment on the impact on TB response from 12 high TB burden countries. This report outlines the key areas of disruption, the specific impacts on TB programs, and the mitigation measures being implemented or planned to address these challenges. The report is structured around the broad areas of work affected, including TB screening, diagnosis, treatment, prevention, community-led activities, private sector engagement, monitoring and evaluation, supply chain management, operational research, technical assistance, capacity building, and other critical activities. This report is based on information received from the countries to the best of our knowledge, however the situation is rapidly evolving in many countries, and we will keep updating the information.

• 1. TB Screening and Active Case Finding (ACF)
• Disruptions:

• Bangladesh: Active Case Finding (ACF) supported by USAID projects (ACTB, TB-DNS) has been interrupted, affecting pediatric TB detection, diabetic clinics in large hospitals, and field operations for 26 portable X-ray systems have been suspended.
• Cambodia: ACF in half of the country has halted, resulting in 100,000 people missing TB screening, 300 DR-TB cases, and 10,000 DS-TB cases potentially going undetected.
• Ethiopia: 5,000 health staff funded by USAID are not working, severely affecting TB screening and detection.
• India:USAID-funded TB screening projects in vulnerable groups (urban slums, poor populations) have stopped.
• Kenya: Supervision of sub-county TB coordinators has halted, impacting case-finding activities.
• Nigeria:Termination of 1,800 staff in 18 high-burden states has affected OPD screening.
• Pakistan: All screening and ACF activities in 27 districts have been suspended.
• Philippines: ACF in 4 USAID projects has been disrupted, and new CXR and mRDT support has halted.
• Tajikistan: Community-based TB case-finding activities under USAID LON project have stopped.
• Tanzania: Direct TB service delivery, including case finding, in 14 regions has ceased.

• Mitigation:

• Bangladesh: The National TB Program (NTP) is reviewing the feasibility of BRAC/Global Fund support to continue ACF activities.
• Cambodia: Exploring adding ACF activities to other donor projects (e.g., L'Initiative/Expertise France and Australia Government).

• 
  2. TB Diagnosis: Rapid Testing, DST, Specimen Transport, and Other Diagnostic Processes Disruptions:

• Bangladesh:Activities at regional reference labs have been affected due to the suspension of USAID-supported microbiologists.
• Cambodia:Cambodia: 25,000 people missed TB diagnoses, and mobile ACF in hard-to-reach populations has been impacted.
• Ethiopia: Specimen transport funded by PEPFAR has been disrupted, though a waiver was granted on 10 February. 316 GeneXperts were recently provided with USAID support, installations were underway when the work stop order happened. Only 61 sites got training so far on how to use them
• Kenya: Sample transport supported by USAID has halted, affecting DS and DR-TB diagnosis
• Nigeria: Outreach activities and sample transportation in 18 states have been affected.
• Pakistan: Diagnostic activities in 27 districts have been disrupted.
• Tajikistan: Technical support by Country Lab TB advisor and SRL Gauting (Germany) has stopped.
• Tanzania: Sample transport for DS and DR-TB in 14 regions has been affected.
• Uganda: Specimen transport reliant on PEPFAR has been disrupted, and the National Medical Stores cannot distribute USAID supplies.
• Uganda: Specimen transport reliant on PEPFAR has been disrupted, and the National Medical Stores cannot distribute USAID supplies.
• Ukraine: USAID country TB project, targeted laboratory support including provision of reagents, equipment, training, certification, etc - work suspended

• Mitigation:

• Cambodia: TB networks and Peer Support Groups are encouraged to refer presumptive TB cases from the community level.
• Kenya: Sample transport may resume once new budgets and workplans are approved.
• Uganda: The NTP is trying to manage specimen transport with existing government resources.

• 3. TB Treatment (Including DR-TB and TB/HIV Treatment) and Treatment Adherence Support
• Disruptions:

• Bangladesh: MDR patient management at hospitals has been affected due to the suspension of dedicated medical doctors from the ACTB project.
• Cambodia: Treatment support for half of the country has been impacted.
• Nigeria: Case holding in OPD services has been affected.
• Philippines: Pilot projects for peer support have halted.
• Tajikistan: Psychosocial adherence support to people with TB by NGOs has stopped.
• Ukraine: TB treatment is affected due to drug supply issues, and psychosocial adherence support to people with TB has been disrupted.

• Mitigation:

• Cambodia: Peer support groups are encouraged to step in, and USAID has been asked for waivers for life-saving activities

• 4. TB Prevention: : Contact Investigation, Testing for TB Infection, and TB Preventive Treatment (TPT)
• Disruptions:

• Bangladesh: TPT activities are at risk due to the suspension of USAID funding.
• Cambodia: Contact screening of 2,500 contacts and 10,000 TPT enrollments have been halted
• Nigeria: TPT activities in 18 states have been affected.
• Pakistan: TPT activities in 27 districts have been disrupted.
• Tanzania: Tanzania: Contact investigations in 14 regions have been affected

• Mitigation:

• Cambodia: USAID has been asked for waivers for life-saving activities.


• 5. Community-Led Activities, Including Community-Supported TB Prevention and Care, Community-Led Monitoring, and Stigma Reduction
• Disruptions:
• Stop TB Partnership’s CFCS work and National partnership forum work stopped in all countries
• Bangladesh: USAID funded Community-led activities, including TB prevention and stigma reduction, have stopped.
• Cambodia: 8,000 people missed TB awareness activities, and support for CLM-OneImpact has halted.
• India: USAID-funded community-led activities, including TB prevention and monitoring, have stopped.
• Nigeria: TB outreach activities have halted.
• Pakistan: CLM activities and stigma reduction work have stopped.
• Tanzania: Community TB services in 3 regions have been affected.
• Ukraine: Pilot interventions for mobilizing local governance and communities for TB elimination have stopped.


• 6. Private Sector Engagement in TB Care
• Disruptions:
• Bangladesh: 4 out of 10 PPM sites those supported by USAID have stopped working.
• Nigeria: PPM activities in USAID-supported states have been affected.
• Pakistan: PPM activities in 27 districts have halted.
• Philippines: Engagement with the Lab Consortium has halted.
• Tanzania: Private sector engagement in 14 regions has been impacted.
• Mitigation:
• Bangladesh: The NTP is asking the Global Fund to support the 4 PPM sites.


• 7. Recording and Reporting, Program Supervision, Monitoring, and Evaluation (M&E)
• Disruptions:
• Bangladesh: Upgradation of the digital TB reporting system (e-TB manager) has stalled.
• Cambodia: TB-MIS support and supervision meetings in USAID areas have stopped.
• Ethiopia: LabXpert connectivity system has been halted.
• Kenya: The TB information system (TIBU) has been impacted, and support for strengthening the TIBU LIMS connectivity system has halted.
• Pakistan: District TB Program Review Meetings supported by USAID will no longer occur.
• Tajikistan: Work on electronic TB recording and reporting system has stopped.
• Tanzania: Sub-national performance review meetings in 14 regions have been affected.
• Ukraine: Support to monitoring visits to regions has been reduced.
• Mitigation:
• Bangladesh: The NTP is asking the Global Fund to support upgrading the e-TB manager.
• Cambodia: Provincial Health Departments continue to monitor health facilities.


• 8. Procurement and Supply Chain of TB Drugs, Diagnostics, and Other Commodities
• Disruptions:
• Bangladesh: Bangladesh: Training on eLMIS has halted.
• Cambodia: Procurement of portable and digital X-ray machines has been delayed.
• Kenya: Drug supplies are likely to be affected soon due to the suspension of USAID-funded county coordinators who were doing the logistic management..
• Nigeria: Procurement of 134,000 Xpert tests has halted.
• Tajikistan: TA for drug quantification and lab supplies has stopped.
• Ukraine: Supply of FLDs and SLDs (procured by USAID) suspended, and the country will face stockouts of drugs starting September 2025.
• Mitigation:
• Bangladesh: : The NTP is asking the Global Fund to support eLMIS training.
• Cambodia: : Follow-up with the Global Drug Facility (GDF) is ongoing


• 9. Surveys and Operational Research
• Disruptions:
• Bangladesh: Initiatives under HS4 TB, including Patient Pathway Assessment and Diagnostic Network Optimization, have stalled.
• Cambodia:Cohort studies and scale-up of IGRA tests have been delayed.
• India: Some capacity-building exercises for surveys and operational research earlier supported by USAID have stopped
• Nigeria: The DRS survey, 90% completed, has been halted.
• Philippines: Pilot studies on urine LF LAM, IGRA, and formative research have stopped.
• Tajikistan: TB infection study in children have stopped.


• 10. External Technical Assistance
• Disruptions:
• Bangladesh: Technical Assistance support with experts/ consultants in PSM, digital tools, and newer diagnostic testing has stopped.
• India: USAID-funded technical assistance in planning, training, and community mobilization has been affected.
• Kenya: Embedded TA supported by USAID has stopped.
• Nigeria: TA for DRS has halted.
• Pakistan: TA provided through TIFA has stopped.
• Philippines: Major TA shortages in health system strengthening and TB program implementation have occurred.
• Tajikistan: TA work by Country TB Advisors funded by USAID has stopped.
• Tanzania: TA for the TB catch-up plan and NTP support has been impacted.


• 11. Capacity Building and Training
• Disruptions:
• Bangladesh: Training on Child TB, CXR, TB-HIV, and e-TB manager has been postponed.
• Cambodia: TA for capacity building of 'TB people' has stalled.
• India: Capacity building in ACF/TPT, AIC, and comorbidity management has been affected.
• Pakistan: Training of Community Champions on TB awareness has halted.
• Philippines: Capacity development in tNGS, diagnostic network optimization, and DRTB management has been severely hampered.
• Ukraine: Training of teachers for TB education program in schools has been interrupted.


• Mitigation:
• Bangladesh: The NTP will cover training costs from Global Fund and domestic funds.


• 12. Other Activities
• Disruptions:
• Philippines: Key activities like the enhancement of the PhilHealth TB benefit package and support for Regional Coordinating Councils have halted.


• Conclusion
• The suspension of US Government funding has caused widespread disruptions across multiple aspects of TB response in high-burden countries. While some mitigation measures are being explored, the long-term impact on TB control efforts could be severe if funding is not restored promptly. Countries are seeking alternative funding sources and waivers to continue critical activities, but the gaps in service delivery, diagnosis, and treatment adherence could lead to increased TB transmission and mortality. Urgent action is needed to address these challenges and ensure the continuity of TB programs.