Genital inflammation screening for predicting sexually transmitted infections and bacterial vaginosis: an updated cost analysis from the GIFT study in Madagascar, South Africa, and Zimbabwe

Abstract Background Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are significant public health issues, particularly in sub-Saharan Africa, and are associated with genital inflammation and increased HIV acquisition risk. A substantial proportion of these infections are asymptomatic, limiting the effectiveness of syndromic management. The Genital InFlammation Test (GIFT), a novel rapid point-of-care (POC) test, was developed to detect elevated inflammatory biomarkers associated with genital inflammation. The first-in-field prototype of the GIFT device was evaluated in a multicenter observational study conducted in South Africa, Zimbabwe, and Madagascar. This study updates prior cost estimates using a hypothetical GIFT prototype in South Africa and extends the analysis to routine family planning services in Madagascar, and Zimbabwe. Methods A provider-perspective, combining a top-down and bottom-up costing approach, was conducted at device evaluation observational study sites in Madagascar, South Africa, and Zimbabwe ( n = 1 per country). Economic costs, including capital and recurrent expenditures, were collected through facility records, interviews, and self-reported provider timesheets to determine the incremental cost of integrating GIFT screening into family planning consultations. Research-related costs were excluded. A probabilistic sensitivity analysis using Monte Carlo simulation was performed to address parameter uncertainty, particularly around GIFT’s estimated market price of US$5.00. Results The incremental cost per woman screened with GIFT was estimated to be US $6.46 (95% CI: US $1.98 – US $12.22) in Madagascar, US $9.05 (95% CI: US $3.78 – US $15.83) in South Africa, and US $8.28 (95% CI: US $3.04 – US $16.52) in Zimbabwe, slightly higher than previous estimates for South Africa (US $3.53 - US$ 5.32). Recurrent costs (personnel, supplies, and overheads) constituted more than 98% of this cost, with the GIFT device being the primary cost driver. Conclusions Updated costs suggest slightly higher implementation costs than previous estimates. This analysis suggests that the affordability and potential scale-up of GIFT and other novel POC screening tools will depend heavily on their final market price. These findings provide essential economic evidence to inform further analyses on cost-effectiveness, affordability, and optimal integration of GIFT into routine sexual and reproductive healthcare services in low- and middle-income countries.