Data collection and assumptions
While exceptions do occur, in general, it is most common that VMMC clients self-paid transportation costs in urban sites and that the program paid for client transportation costs in rural areas. These transportation commonalities are reflected in the payer perspective, representing CHAPS costs as part of their overall VMMC program costs funded by the major VMMC donor, PEPFAR. This is the most prevalent model of VMMC funding and was assumed for the current approach.For the costing study, data were collected from three main sources: 1) RCT databases of routine VMMC data including client visits, AEs, and follow-up tracing; 2) the 2wT database; and 3) time-and-motion surveys designed for the costing component of the study. The first source, the RCT databases, included de-identified routine VMMC data on the number of visits attended, the number/type/severity of AEs, and the number of traced clients, by tracing method (phone and/or home visit). Visit costs associated with the study day 14 visit were excluded since it was specific to the RCT study and not considered routine VMMC follow-up care. The 2wT database contained enrolment data including transportation costs to the clinic. The 2wT database also included counts of inbound and outbound SMS. RCT-specific activities (e.g., additional consenting, RCT monitoring forms) were also not included in time-and-motion data.Based on Time and Motion Form (It is assumed that (1) all fixed costs related to post-operative follow-ups were in place, and hence we focus on analysing marginal costs in serving an additional VMMC client in the system; (2) that full-time employees worked a 40-hour workweek or 160 hours per month; (3) that nurse counselling time was 5 minutes in routine counselling and 10 minutes for 2wT counselling; (4) that the nurse spent one minute per SMS response on average, and (5) that the average phone call time with a VMMC client was 5 minutes.