Cost analysis of genital inflammation screening as a predictor of sexually transmitted infections and bacterial vaginosis in women: evidence from the GIFT study in Madagascar, South Africa, and Zimbabwe

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 a syndromic approach. The Genital InFlammation Test (GIFT), a rapid point-of-care (POC) test, was developed to detect increases in 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. While previous cost estimates for a hypothetical GIFT prototype exist for South Africa, this study provides an updated, real-world cost analysis of implementing GIFT screening within routine family planning services in South Africa and extends this analysis to 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. 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. Recurrent costs (personnel, supplies, and overheads) constituted more than 98% of this cost, with the GIFT device being the primary cost driver. Conclusions 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. The findings provide critical economic evidence to inform the broader adoption of GIFT into routine practice, including cost-effectiveness, affordability, and optimal strategies for its integration into sexual and reproductive healthcare services in low- and middle-income countries.