{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:08:50Z","timestamp":1790154530451,"version":"4.0.1"},"reference-count":43,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI152126"],"award-info":[{"award-number":["R01AI152126"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1171455"],"award-info":[{"award-number":["OPP1171455"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","award":["015NEWTON TB"],"award-info":[{"award-number":["015NEWTON TB"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2024,11,18]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>To ensure there is adequate investment into diagnostics, an understanding of the magnitude of impact and return on investment is necessary. We, therefore, sought to understand the health and economic impacts of the molecular diagnostic programme in South Africa, to deepen the understanding of the broad value of diagnostics and guide future healthcare investments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We calculated the 10-year (where data were available) total cost and disability-adjusted life-years (DALYs) averted associated with molecular testing for tuberculosis diagnosis (2013\u20132022), HIV viral load monitoring (2013\u20132022), early infant diagnosis of HIV infection (2013\u20132022) and SARS-CoV-2 testing (2020\u20132022), based on the actual number of molecular tests conducted in South Africa for the respective time periods. We then calculated the economic value associated with those health gains and subsequent return on investment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Since the inception of the molecular diagnostics programme in South Africa, approximately 4.3\u2009million DALYs (uncertainty range (UR): 2.8\u20135.8\u2009million) have been averted as a direct consequence of this programme. This has generated an estimated US$28.3\u2009billion in economic value due to these health gains (UR$18.4\u2013UR$38.7\u2009billion). The return on investment varied by specific diagnostic test (20.3 (UR 15.2\u201325.4) for tuberculosis, 7.7 (UR 1.6\u201313.9) for HIV viral load testing, 63.0 (UR 63.0\u201365.5) for early infant diagnosis of HIV and 2.5 (UR 0.7\u20134.6) for SARS-CoV-2), for an average of 13.9 (UR 9.0\u201318.9) for the entire molecular diagnostics programme or US$13.9 of value for each UR$1 invested.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The molecular diagnostics programme in South Africa generated a significant amount of health gains and economic value associated with these health gains. The return on investment rivals other high-impact public health interventions such as childhood vaccination. The molecular diagnostics programme in South Africa is highly impactful and will continue to be an excellent investment in South African public health expenditure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-015830","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T01:20:17Z","timestamp":1733275217000},"page":"e015830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Ten-year health impact, economic impact and return on investment of the South African molecular diagnostics programme for HIV, tuberculosis and SARS-CoV-2"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke E","family":"Nichols","sequence":"first","affiliation":[{"name":"Impact Department, FIND, Geneva, Switzerland"},{"name":"Department of Global Health, Boston University School of Public Health, Boston, MA, USA"},{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Department of Global Health, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"de Nooy","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naseem","family":"Cassim","sequence":"additional","affiliation":[{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Hans","sequence":"additional","affiliation":[{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"National Health Laboratory Service, Johannesburg, South Africa"},{"name":"Department of Molecular Medicine and Haematology, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Pedro","family":"da Silva","sequence":"additional","affiliation":[{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamy","family":"Chetty","sequence":"additional","affiliation":[{"name":"National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyra H","family":"Grantz","sequence":"additional","affiliation":[{"name":"Impact Department, FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin X","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N","family":"Phillips","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"Jamieson","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa"},{"name":"The South African Department of Science and Innovation\/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley E","family":"Scott","sequence":"additional","affiliation":[{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy S","family":"Stevens","sequence":"additional","affiliation":[{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025072914061859000_9.12.e015830.1","unstructured":"African Region - World Health Organization (W.H.O) . 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