Published in PLOS One on 2026-06-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Obinna Ekwunife, Collin Mangenah, Lucky Ngwira, Elizabeth Corbett, Karin Hatzold, Elvis Isere, John Bimba, Euphemia Sibanda, Frances M Cowan, Godpower Omoregie, Gabrielle Bonnet, Ibrahim Jahun
Source: PLOS One • DOI 10.1371/journal.pone.0350288
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
While the acute phase of the COVID-19 pandemic has passed, understanding the economic barriers to diagnostic access remains critical for future pandemic preparedness and universal health coverage. Implementing efficient testing modalities is crucial to achieving optimal value for both clients and healthcare providers. This study examines the cost and affordability of various SARS-CoV-2 antigen rapid-diagnostic-test modalities in Nigeria, Malawi, and Zimbabwe from a client perspective, providing a blueprint for future diagnostic strategies in Sub-Saharan Africa. Testing was offered for free through professional testing and self-testing in government or NGO-led primary healthcare centers across all countries, and in community pharmacies and drug stores in Nigeria. Data were collected from October 2022 to May 2023 through a survey of a random sample of adults visiting participating sites. The survey collected patient costs, including transportation, medical and non-medical expenses, and productivity loss. Affordability was assessed by the incidence of catastrophic health expenditure (defined as costs exceeding 10% of household income). The unit patient cost of testing in Nigeria, Malawi and Zimbabwe was $4.2, $2.7 and $2.7, respectively. In Nigeria, testing in community pharmacies and drug stores was cheaper than in primary healthcare centers. Self-testing cost less than professional testing in Nigeria ($1.3 versus $9.8), but more in Zimbabwe ($3.2 versus $2.3). In Malawi, Nigeria and Zimbabwe 40.6%, 28.6%, and 5.7% of clients, respectively, faced catastrophic health expenditures. SARS-CoV-2 antigen testing imposes a significant financial burden on clients. Even “free” testing carries high indirect costs that threaten diagnostic equity. Diversified testing modalities, such as community pharmacies and drug stores, may offer lower-cost options for sustainable diagnostic integration.
Background
The coronavirus disease (COVID-19) resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led to significant mortality and morbidity since its initial reporting in December 2019. While the global health emergency has transitioned, the lessons learned regarding diagnostic infrastructure remain vital for health system strengthening. Testing, along with isolation, contact tracing, and the use of personal protective equipment (PPE), was essential to the response. While nucleic acid amplification testing (NAAT) is the diagnostic reference, antigen-detection rapid diagnostics tests (Ag-RDTs) are also recommended due to their ease of use and rapid results. [1] Ag-RDTs are particularly suited for resource-constrained settings since shortages of NAAT testing supplies, limited skilled laboratory personnel, high costs, and logistical challenges are common. The practice and knowledge related to SARS-CoV-2 Ag-RDTs could serve as a foundation for the timely identification of other endemic diseases and new variants. [2]
Guaranteeing affordable diagnostic access for everyone in sub-Saharan Africa is essential to prevent access disparities based on socioeconomic status. In the post-pandemic era, empirical data on patient-side costs is required to design sustainable health policies. In contexts where patients incur out-of-pocket expenses, these costs can discourage individuals from getting tested. Affordable testing diminishes these barriers, encouraging individuals to pursue testing without the weight of financial burden.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Obinna Ekwunife, Collin Mangenah, Lucky Ngwira, Elizabeth Corbett, Karin Hatzold, Elvis Isere, John Bimba, Euphemia Sibanda, Frances M Cowan, Godpower Omoregie, Gabrielle Bonnet, Ibrahim Jahun. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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