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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091 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\u2019s estimated market price of US$5.00.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incremental cost per woman screened with GIFT was estimated to be US $6.46 (95% CI: US $1.98 \u2013 US $12.22) in Madagascar, US $9.05 (95% CI: US $3.78 \u2013 US $15.83) in South Africa, and US $8.28 (95% CI: US $3.04 \u2013 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-026-04428-9","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T08:53:16Z","timestamp":1778748796000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1186","volume":"26","author":[{"given":"Elise","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina","family":"Harimanana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinashe","family":"Mwaturura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaomalala","family":"Raharimanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora Mayouya","family":"Gamana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Harding-Esch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Crucitti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindi","family":"Masson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-Ann","family":"Passmore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edina","family":"Sinanovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"4428_CR1","unstructured":"World Health Organization. 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The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, and all applicable national and institutional guidelines for research involving human participants were followed. All human participants provided informed consent to participate in this research as part of the GIFT multicenter observational study (EDCTP-RIA2020I-3297).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Jo-Ann Passmore and Lindi Masson are co-inventors on a patent related to the combination of three inflammatory biomarkers (IL-1\u03b1, IL-1\u03b2, and IP-10) used in the GIFT diagnostic assay for genital inflammation (South African Patent No. 2016\/03606 and European Patent No. 14809984.9). Both inventors declare that while this intellectual property is related to the biomarker combination evaluated in the current study, neither they nor their institutions currently receive personal financial benefits from the patent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"340"}}