Cost estimates

We estimated the costs using micro-costing from patient level data using the patient level questionnaire where they reported direct medical, non-medical and indirect costs incurred from health-related visits over a six-month period prior to enrolment in the study. Direct medical costs referred to costs incurred for consultation, medication, diagnostic and monitoring tests while non-medical costs were related to travel, accommodation and other costs associated with the health-related visits. Indirect costs included opportunity costs associated with travel time and time spent in the health facility. The source of income was provided by participants in the questionnaire while the hourly rate was estimated by looking at the prevailing wage of that occupation as provided in the literature (see Table 1). We calculated the opportunity cost in three ways: 1) we used actual income estimates for those participants who received a wage from actual work and not passive or no income at all; 2) We allocated 1 to all the participants who had a passive income or not receiving an income at all and 3) we varied the income to the sectoral minimal rate and the maximum casual wage rate. This income was given at 2016 rates. The currency used was 2016 United States Dollars at the December 2016 average exchange rate of 1 US Dollar: 13.38 South African Rands (ZAR) [5] where applicable. No discount rate was applied. Costs were stratified by the type of service the clients were receiving i.e. ART or PMTCT.