Limitations
pain
HOLIDAYS
There are several assumptions and limitations in this study. First, this study focuses on the cost of the activities to serve an average client presuming that 2wT is implemented within an existing routine VMMC service. Therefore, start-up costs (e.g., developing text message library, translation to local languages, adaptation to South Africa context) and fixed costs (e.g., full-time employment dedicated to 2wT, cell phones, computers, vehicle purchase, insurance, maintenance cost) were excluded. Second, we conducted costing from the perspective of the VMMC program and current guidelines to inform feasibility of adoption by the NDoH, assuming the existing VMMC donors would continue support for at least the 5-year time frame. However, with any payer (Ministry of Health, donor, or program), and evolving guidelines, 2wT costs and comparators could change over time. Third, we used the standard workweek in South Africa, i.e., 5 days per week, from Monday to Friday. In calculating hourly wage, we used the salary of the Enrolled Nurse cadre and did not take into account that some nurses work on weekends and public holidays or may have additional days off, such as annual leave or sick leave–considerations that could affect costs. For AE management, only costs related to reportable moderate and severe cases are documented and noted in this study. We did not measure the costs to manage mild AEs such as pain. Lastly, we explored will see savings (monetary cost) in reduced transportation fuel costs that the reduced staff time required for follow-up (an opportunity cost not a monetary cost savings) means that overall monetary costs to the program are likely to increase.