{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:08:57Z","timestamp":1790154537619,"version":"4.0.1"},"reference-count":26,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"unspecified","delay-in-days":17,"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":["U01AI152087"],"award-info":[{"award-number":["U01AI152087"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EDCTP2 programme supported by European Union","award":["RIA2017S-2007-TB-CAPT"],"award-info":[{"award-number":["RIA2017S-2007-TB-CAPT"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,10,8]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In low- and middle-income countries (LMICs), tuberculosis (TB) regained its status as the leading cause of death from a single infectious agent in 2023, surpassing COVID-19. Rapid and accurate diagnosis is critical, with decentralised diagnostic strategies offering a promising solution. Although decentralised diagnostic strategies have been proven cost-effective, further evidence is needed on affordability and equity in high-burden settings. This study, part of a multicentre real-world cluster-randomised controlled trial (cRCT), assessed implementation costs and out-of-pocket (OOP) expenditures across socioeconomic status (SES) groups from a societal perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The TB-CAPT Core trial compared decentralised point-of-care TB testing using the Molbio Truenat platform (intervention) with the hub-and-spoke Xpert MTB\/RIF Ultra model (control) in Tanzania and Mozambique. Economic data were collected as part of the trial along with asset ownership information using an equity tool. Multiple correspondence analysis was used to construct an asset index for each country. Extended cost-effectiveness analysis estimated incremental participant costs for TB diagnosis and health outcomes (number of participants who initiated treatment within seven and sixty days) across SES groups. Distributional cost-effectiveness analysis assessed facility-based diagnostic cost per treatment initiated from a societal perspective across SES groups. Regression analyses explored the intervention\u2019s impact on direct, indirect and total costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Average OOP expenditures were lower in the intervention arm (US$8.82) than in the control group (US$13.61). Regression analysis confirmed a significant cost reduction. Least poor participants experienced greater cost-savings (\u2212US$6.36 vs \u2212US$2.93), while the poorest had a higher number of TB treatment initiations within 7\u2009days of diagnosis (poorest vs least poor: 28 vs 8). The incremental cost-effectiveness ratio for the poorest group was US$778, whereas for the other two groups, the intervention showed higher treatment initiation (52 vs 36 for middle, 33 vs 25 for least poor) at lower costs than the standard of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The intervention reduced patient costs and improved outcomes across SES groups. Decentralised TB testing with the Molbio Truenat platform is both cost-saving and more effective and cost-effective compared with a hub-and-spoke model in Mozambique and Tanzania.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2025-020117","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T17:30:14Z","timestamp":1763573414000},"page":"e020117","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["An extended cost-effectiveness analysis of decentralised TB diagnostic testing with Molbio Truenat MTB\/RIF versus hub-and-spoke GeneXpert MTB\/RIF in Mozambique and Tanzania"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4558-9432","authenticated-orcid":false,"given":"Saima","family":"Bashir","sequence":"first","affiliation":[{"name":"Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany"},{"name":"University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-3349","authenticated-orcid":false,"given":"Lelisa Fekadu","family":"Assebe","sequence":"additional","affiliation":[{"name":"Global Public Health and Primary Care Medicine, University of Bergen, Bergen, Norway"},{"name":"Disease Prevention and Control, Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9lio","family":"El\u00edsio","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a Manhi\u00e7a, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Machiana","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade (INS), Marracuene, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anange","family":"Lwilla","sequence":"additional","affiliation":[{"name":"National Institute for Medical Research, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Hella","sequence":"additional","affiliation":[{"name":"Tuberculosis Research Group, Ifakara Health Institute, Ifakara, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neenah","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaela","family":"Watson","sequence":"additional","affiliation":[{"name":"FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinzeigh","family":"Leukes","sequence":"additional","affiliation":[{"name":"FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Penn-Nicholson","sequence":"additional","affiliation":[{"name":"FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Ruhwald","sequence":"additional","affiliation":[{"name":"FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4869-4630","authenticated-orcid":false,"given":"Leyla","family":"Larsson","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine, Ludwig Maximilians University Munich, Munchen, Germany"},{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dowdy","sequence":"additional","affiliation":[{"name":"Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8677-1337","authenticated-orcid":false,"given":"Manuela","family":"De Allegri","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7216-7067","authenticated-orcid":false,"given":"Claudia M","family":"Denkinger","sequence":"additional","affiliation":[{"name":"Center of Infectious Disease, Heidelberg University, Heidelberg, Germany"},{"name":"German Center for Infection Research (DZIF), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025111909300636000_10.11.e020117.1","unstructured":"World Health Organization . Global tuberculosis report 2024, report no.: licence: CC BY-NC-SA 3.0 IGO. 2024."},{"key":"2025111909300636000_10.11.e020117.2","unstructured":"World Health Organization . WHO operational handbook on tuberculosis. Module 3: diagnosis-rapid diagnostics for tuberculosis detection. 2024."},{"key":"2025111909300636000_10.11.e020117.3","doi-asserted-by":"crossref","first-page":"e278","DOI":"10.1016\/S2214-109X(22)00509-5","article-title":"Multicomponent strategy with decentralised molecular testing for tuberculosis in Uganda: a cost and cost-effectiveness analysis","volume":"11","author":"Thompson","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2025111909300636000_10.11.e020117.4","doi-asserted-by":"crossref","unstructured":"Dowdy DW . Minding the gap: specimen referral systems for diagnosis of infectious diseases. 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The effect of implementing the molbio truenat platform and tuberculosis assays at primary health care clinics in Mozambique and Tanzania. TB-CAPT CORE."},{"key":"2025111909300636000_10.11.e020117.8","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-04345-x","article-title":"A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients","volume":"12","author":"Ghazy","year":"2022","journal-title":"Sci Rep"},{"key":"2025111909300636000_10.11.e020117.9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40249-019-0519-7","article-title":"Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios","volume":"8","author":"Fuady","year":"2019","journal-title":"Infect Dis Poverty"},{"key":"2025111909300636000_10.11.e020117.10","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00193413"},{"key":"2025111909300636000_10.11.e020117.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.01.046"},{"key":"2025111909300636000_10.11.e020117.12","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.5588\/ijtld.22.0091","article-title":"The household economic burden of drug-susceptible TB diagnosis and treatment in The Gambia","volume":"26","author":"Devoid","year":"2022","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025111909300636000_10.11.e020117.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-036892","article-title":"Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey","volume":"10","author":"Assebe","year":"2020","journal-title":"BMJ Open"},{"key":"2025111909300636000_10.11.e020117.14","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-018-0146-0"},{"key":"2025111909300636000_10.11.e020117.15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-1"},{"key":"2025111909300636000_10.11.e020117.16","doi-asserted-by":"crossref","first-page":"e1640","DOI":"10.1016\/S2214-109X(23)00369-8","article-title":"Costs incurred by people receiving tuberculosis treatment in low-income and middle-income countries: a meta-regression analysis","volume":"11","author":"Portnoy","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2025111909300636000_10.11.e020117.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0004724","article-title":"Decentralized TB diagnostic testing with Truenat MTB Plus and MTB-RIF Dx vs. hub-and-spoke GeneXpert MTB\/RIF Ultra in Mozambique and Tanzania: a cost and cost-effectiveness analysis","volume":"5","author":"Malhotra","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"2025111909300636000_10.11.e020117.18","unstructured":"Wage indicator. 2024. 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