Abstract:

Microbiological testing underpins effective antimicrobial resistance (AMR) surveillance; however, its financial implications remain poorly characterized in resource-limited settings. This study evaluated the time, labor, and cost components of biochemical and antimicrobial susceptibility testing (AST) in Zambia. Between December 2024 and March 2025, data were collected from 13 laboratories across nine provinces using structured questionnaires. Inputs related to labor and time, reagents, and equipment were analysed using the WHO Laboratory Testing Costing Tool (LTCT) and Julius AI, with pricing guided by the Zambia Public Procurement Act. Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee (UNZABREC) and the National Health Research Authority (NHRA). A mixed-methods approach was employed to complement quantitative costing with contextual insights. Biochemical tests clustered into two categories based on time requirements: high-intensity tests averaging 78 minutes and rapid tests averaging 13 minutes. Despite this variation, costs ranged from USD 4.25 to 7.99 per test, with rapid tests such as Coagulase being the most expensive due to specialized reagent needs. AST using Mueller Hinton media averaged USD 11.86 per test, with reagents accounting for over 88% of total expenditure. Across all test types, reagent costs dominated, while labor and equipment contributed minimally. Findings reveal a disconnect between test duration and cost, underscoring that efficiency gains are limited primarily by reagent pricing rather than workflow optimization. Strategic procurement, local reagent production, and targeted cost-control measures are essential to sustain affordable microbiological diagnostics in Zambia and similar low-resource settings.

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