TY - JOUR
T1 - Provider costs of professional COVID-19 rapid antigen testing in low-income settings
AU - Mangenah, Collin
AU - Ngwira, Lucky G.
AU - Ekwunife, Obinna
AU - Sande, Linda
AU - Bonnet, Gabrielle
AU - Chiwawa, Progress
AU - Mashoko, Linea
AU - Nkhoma, Desiderata
AU - Mwase, Norah
AU - Isere, Elvis
AU - Kabonga, Itai
AU - Watadzaushe, Constancia
AU - Chinoruma, Rudo
AU - Dunkley, Yasmin
AU - Choko, Augustine
AU - Bimba, John S.
AU - Maponga, Brian
AU - Taruberekera, Noah
AU - Sibanda, Euphemia
AU - Cowan, Frances M.
AU - Hatzold, Karin
AU - Corbett, Elizabeth L.
N1 - Publisher Copyright:
© 2025 Mangenah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/10/8
Y1 - 2025/10/8
N2 - World Health Organization recommends antigen rapid diagnostic tests (RDT) as point of care tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in suspected outbreaks when polymerase-chain-reaction testing is not accessible; to trace the extent of outbreaks; and in areas with widespread community transmission. Annual economic costs were estimated for professional SARS-CoV-2 testing as part of several COVID-19 testing use cases in Malawi, Nigeria and Zimbabwe. Symptom screening and antigen-based RDT was implemented as part of a multi-country, Unitaid/STAR 3ACP (Africa, Asia, America COVID-19 Prevention) funded project (April 2022-June 2023). Testing services were provided through trained health providers in outpatient departments of primary care facilities (Malawi and Nigeria) and two primary non governmental organisation (NGO) use cases separately targeting key population (KP) and the general population in Zimbabwe. Combined financial expenditure analysis and on-site micro-costing took the provider/health system perspective in 2025 US$. Per test average costs were $9.73 (range across sites: $5.49-$29.90) in Malawi, $13.99 ($11.64-US$18) in Nigeria and $10.11 ($4.19-$209.09) and $19.98 ($10.76-$56.40) in Zimbabwe for general population and key population clinics respectively. Average costs per positive case identified were $521 ($61-$800) in Malawi; $1,118 ($202.66-$4,804.45) in Nigeria; and $1,125 ($336-$ 1,762) and $187 ($161-$ 1,272) in Zimbabwe. Major cost contributors were test kits in Malawi, test kits and building (consultation room space costs) and storage in Nigeria and personnel and training in Zimbabwe. Excluding above site level costs, the average cost per SARS-CoV-2 test was $9.73 in Malawi, $13.99 in Nigeria and $10.70 and $9.79 in Zimbabwe. Integrating COVID-19 testing into existing sites can reach people at high risk of severe illness at a reasonable cost. For resource-limited settings where programmes are threatened by low fiscal space, costs might be reduced when scaling up, through greater spreading of startup and capital costs.
AB - World Health Organization recommends antigen rapid diagnostic tests (RDT) as point of care tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in suspected outbreaks when polymerase-chain-reaction testing is not accessible; to trace the extent of outbreaks; and in areas with widespread community transmission. Annual economic costs were estimated for professional SARS-CoV-2 testing as part of several COVID-19 testing use cases in Malawi, Nigeria and Zimbabwe. Symptom screening and antigen-based RDT was implemented as part of a multi-country, Unitaid/STAR 3ACP (Africa, Asia, America COVID-19 Prevention) funded project (April 2022-June 2023). Testing services were provided through trained health providers in outpatient departments of primary care facilities (Malawi and Nigeria) and two primary non governmental organisation (NGO) use cases separately targeting key population (KP) and the general population in Zimbabwe. Combined financial expenditure analysis and on-site micro-costing took the provider/health system perspective in 2025 US$. Per test average costs were $9.73 (range across sites: $5.49-$29.90) in Malawi, $13.99 ($11.64-US$18) in Nigeria and $10.11 ($4.19-$209.09) and $19.98 ($10.76-$56.40) in Zimbabwe for general population and key population clinics respectively. Average costs per positive case identified were $521 ($61-$800) in Malawi; $1,118 ($202.66-$4,804.45) in Nigeria; and $1,125 ($336-$ 1,762) and $187 ($161-$ 1,272) in Zimbabwe. Major cost contributors were test kits in Malawi, test kits and building (consultation room space costs) and storage in Nigeria and personnel and training in Zimbabwe. Excluding above site level costs, the average cost per SARS-CoV-2 test was $9.73 in Malawi, $13.99 in Nigeria and $10.70 and $9.79 in Zimbabwe. Integrating COVID-19 testing into existing sites can reach people at high risk of severe illness at a reasonable cost. For resource-limited settings where programmes are threatened by low fiscal space, costs might be reduced when scaling up, through greater spreading of startup and capital costs.
U2 - 10.1371/journal.pgph.0005251
DO - 10.1371/journal.pgph.0005251
M3 - Article
AN - SCOPUS:105018843896
SN - 2767-3375
VL - 5
JO - PLOS Global Public Health
JF - PLOS Global Public Health
IS - 10
M1 - e0005251
ER -
