About Voluntary Medical Male Circumcision
VMMC is a common procedure for males that has been shown to help reduce the spread of HIV. VMMC is safe and effective with few post-operative complications. To ensure the highest quality care, males who undergo VMMC should have a follow-up appointment between days 2-14 post-surgery to ensure healthy healing and swift referral to care for any potential complication. However, routine follow-up care for VMMC requires in-person visits which are burdensome and largely unnecessary as 99% of patients heal without complications. 2wT-based follow-up allows patients to report on their healing process, receive education on wound care, and communicate with their providers via text for the first 14 days after VMMC.
How 2wT works for VMMC
2wT is a hybrid mHealth model integrating both automated SMS and individualized mHealth messaging between clients and a routine VMMC nurse. Adult males ages 15 and above can enroll if they have a phone with them at their VMMC appointment. On day 0, the day of the VMMC procedure, 2wT clients are asked if they would like to enroll into 2wT-based follow-up. The enrollment text confirms that the number works and initiates communication. Clients who enroll can always come in for visits if they prefer, whether or not they enroll into 2wT. Before leaving the VMMC clinic, 2wT clients receive enhanced post-operative counselling using a 2wT flipbook with additional wound care guidance, photos of complication warning signs, and instructions on how to respond to the daily SMS. 2wT-specific counseling helps 2wT clients understand the automated daily message that asks about the five common complications (i.e., bleeding, swelling, pus, redness, and wound opening). Before they leave, males are better prepared to take ownership over their wound care. They also take wound care pamphlets with them to review bandage removal instructions and emergency numbers. Remember: 2wT is not for emergencies!
Once discharged, 2wT participants opt to receive automated daily texts on select post-operative days 1-13 in local languages – English, Shona, Ndebele, Setswana, or Zulu. They can respond in any language. The automated text messages read, “are you experiencing any bleeding, swelling, pus, pain, redness, wound opening, or other concern? Enter 1 = Yes; 0 (Zero) = No / I’m Ok, and press send.” Receiving and sending text messages is free for clients. If any participant sends in a concern or requests help, a VMMC nurse communicates further via SMS or calls the client, if requested. 2wT clients are not required to attend any clinic visits but could at any time if they desire. For 2wT men with a potential complication or with the need for further reassurance, the nurse triages the participants for clinical visits the following day or earlier if an emergency is suspected. If 2wT clients do respond to the text messages by day 4, a prompt tells the nurse to follow-up with the client to ensure they are healing well. Over 75% of clients respond to at least one message – which is higher than the in-person follow-up attendance rate.
Benefits for Clients and the Healthcare System
2wT has been proven to provide benefits to both clients and the healthcare system overall. For clients, 2wT reduces unnecessary in-person visits but still allows those who want or need care to seek in-person care. Clients who might be interested in VMMC but have limited time or resources are more likely to seek services if they do not need to return to the health facility multiple times.
2wT also provides benefits to the healthcare system. 2wT frees healthcare worker time to focus on those who need more support while allowing most males to recover in the comfort of their homes. 2wT increases the demand for services, thereby helping to reduce the HIV burden across a country. 2wT also assists with swift identification of adverse events. 2wT also increases access to services, allowing healthcare providers to travel out to more remote areas while still providing follow-up care to clients from other areas.
For more specifics on 2wT for VMMC, please see the South Africa and Zimbabwe pages.