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
Bibliographic Data
| ID | 19592873 |
|---|---|
| Authors | Akash Malhotra (0000-0002-9298-0936, Johns Hopkins University, corresponding author), Délio Elísio (Manhiça Health Research Centre, corresponding author), Antonio Machiana (Instituto Nacional de Saúde, corresponding author), Anange Lwilla (0000-0002-8011-6948, National Institute for Medical Research, corresponding author), Jerry Hella (0000-0003-2392-8592, Ifakara Health Institute, corresponding author), Neenah Young (0009-0005-6505-7088, Johns Hopkins University, corresponding author), Celso Khosa (0000-0001-6701-4202, Instituto Nacional de Saúde, corresponding author), Marta Cossa (0009-0006-4041-1500, Manhiça Health Research Centre, corresponding author), Dinis Nguenha (0000-0001-9921-2609, Manhiça Health Research Centre, corresponding author), Regino Mgaya (National Institute for Medical Research, corresponding author), Catildo Cubai (0000-0002-6607-9554, Instituto Nacional de Saúde, corresponding author), Mikaela Watson (0000-0001-7941-1643, FIND, corresponding author), Vinzeigh Leukes (0000-0002-9864-874X, FIND, corresponding author), Lelisa Fekadu (Harvard Global Health Institute, corresponding author), Saima Bashir (0000-0002-3991-6644, Manchester Academic Health Science Centre, corresponding author), Adam Penn-Nicholson (0000-0002-1883-0059, FIND, corresponding author), Morten Ruhwald (0000-0002-1597-441X, FIND, corresponding author), Leyla Sophie Larsson (0000-0003-4869-4630, Ludwig-Maximilians-Universität München, corresponding author), Leyla Larsson, Monisha Sharma (0000-0002-7599-1561, University of Washington, corresponding author), Katharina Kranzer (0000-0001-5691-7270, German Center for Infection Research, corresponding author), Claudia M Denkinger (0000-0002-7216-7067, Heidelberg University, corresponding author), David Dowdy (0000-0003-0481-7475, Johns Hopkins University, corresponding author) |
| Editors | Sizulu Moyo (0000-0002-5296-3242) |
| Year | 2025 |
| Volume | 5 |
| Issue | 5 |
| Pages | e0004724 |
| Publication date | 2025-05-30 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0004724 |
| PMID | 40446169 |
| OpenAlex | W4410884981 |
| Language | EN |
| Citations received | 3 |
| References cited | 8 |
In low-and middle-income countries, missed or delayed tuberculosis (TB) diagnoses contribute to avoidable morbidity, mortality, and transmission. Decentralized testing platforms, such as the Molbio Truenat, may offer solutions by providing accurate point-of-care testing, improving access, and lowering out-of-pocket costs. Despite these advantages, the overall cost and cost-effectiveness of identifying additional TB cases using the Truenat MTB assays remain inadequately explored and understood. We collected economic data from a multicentre randomized controlled trial of TB testing using decentralized Molbio Truenat platform with MTB Plus and MTB-RIF Dx assays (Truenat MTB assays) versus hub-and-spoke Xpert MTB/RIF Ultra (standard of care) in Tanzania and Mozambique (TB-CAPT Core trial). We estimated facility-based diagnostic cost per participant tested and incremental facility-based diagnostic cost per incremental participant initiating TB treatment within seven and sixty days from enrolment. We used the societal perspective and conducted sensitivity analyses to determine key drivers of cost-effectiveness. The facility-based diagnostic cost per participant initiating treatment within seven days from enrolment in Mozambique was $853(95% uncertainty range: $707, $1072) for hub-and-spoke testing and $690($588, $823) for decentralized testing; in Tanzania costs were $596($485, $746) for hub-and-spoke testing and $592($495, $715) for decentralized testing. At sixty days, costs per treatment initiation were $581($493, $706) for hub-and-spoke vs. $678($576, $811) for decentralized testing in Mozambique, and $391($324, $476) vs. $591($494, $716) in Tanzania. Comparing decentralized to hub-and-spoke testing, the incremental cost per incremental seven-day treatment initiation was $403(-$103, $941) in Mozambique and $580($167, $1638) in Tanzania, and $805(-$10107, $10560) and -$353(-$20299, $20802) for sixty-day treatment initiation, respectively. Utilization (i.e., testing volume) of decentralized equipment was the strongest driver of cost-effectiveness. Decentralized TB testing with Truenat MTB assays is cost-effective relative to hub-and-spoke testing in Mozambique and Tanzania
Diagnostic test · GeneXpert MTB/RIF · Geography · Mycobacterium tuberculosis · Pathology · Tanzania · Tuberculosis · Medicine · Pneumonia and Respiratory Infections · Tuberculosis Research and Epidemiology · Emergency Medicine
Diagnostic completeness
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
User perspectives on the Molbio Truenat platform and tuberculosis assays for decentralised testing in Mozambique and Tanzania
| Citations per year | 3 |
|---|---|
| Citation span | 2025 - 2026 (2) |
| Highly cited | No |