Zimbabwe faces a critical shortage of healthcare workers and limited health resources, making it an ideal location for digital innovations that improve the quality of care while reducing healthcare workload. 2wT was designed, developed, and scaled first in Zimbabwe as a collaboration between I-TECH, Zim-TTECH, and Medic, starting as an RCT and scaling up to reach >35,000 males by 2023.  Years of strong evidence from rigorous evaluation of 2wT in Zimbabwe shows that  2wT improved care quality, increased identification of post-operative complications, and reduced follow-up costs as compared to required in-person visits.  Using 2wT was especially beneficial during the COVID-19 pandemic because it allowed patients to receive high-quality care via 2wT while limiting in-person contact.

Rigorous evidence shows that 2wT is safe for post-operative care 

The RCT (ClinicalTrials.gov ID: NCT04327271), conducted between June 7, 2021 and February 21, 2022 with 1,084 males determined that 2wT improved the quality of post-operative care, helping men to identify issues swiftly and report to the clinic for prompt care. 2wT reduced follow-up visit workload by 85% by triaging only those with concerns to care while most men communicated via SMS for wound care support or reassurance. The clients liked 2wT: 94% responded to ≥1 daily SMS text messages over their more intensive 13 days of 2wT-based follow-up. With clear client demand for 2wT in both rural and urban settings in South Africa, and added benefits of reduced costs, 2wT is ready for scale-up.  

2wT for post-operative care saves money 

Using 2wT for follow-up instead of required post-operative reviews saves over $3 per enrolled client, with savings ranging from $2 to $7. 2wT saves more money in rural than urban locations, reducing the costs of care over large geographic areas. 2wT does not replace all in-person reviews: some men have complications, want in-person reassurance, or do not have phones. However, with high client demand for 2wT and widespread access to basic phones, 2wT can reach the majority of males in most locations. Implementing the 2wT approach alongside access to in-person reviews for those males who want or need reviews would have dramatic impact at scale. For 1 million more VMMCs in South Africa alone, 2wT could save millions of dollars to reinvest in VMMC demand creation or quality services. 

Healthcare workers want 2wT for patient follow-up 

Healthcare providers using 2wT felt confident, comfortable, satisfied, and well-supported to provide quality care to their clients. Nurses love the convenience of 2wT and believe that 2wT reduced the challenges caused by distances between patients and providers. Nurses appreciated being able to communicate via SMS, reducing their travel burden. Nurses also were pleased that male clients interacted with them with ease, reported concerns promptly, and responded well to both wound care guidance and reassurance. 2wT is more efficient post-operative care, but it does not remove all workload. 2wT is not a chatbot: nurses must communicate directly, and in a timely manner, with clients – a new workload largely offset by reduced travel time and dramatic reduction in post-operative reviews. Nurses also note that good post-operative counselling and sufficient staffing are critical for success – factors that also affect the quality of VMMC service delivery overall.  

Clients want 2wT – based follow-up 

Clients liked the 2wT telehealth approach for its convenience, care quality, and confidentiality. Clients reported confidence in getting help via 2wT with the time and cost benefits of getting support at their convenience. Clients also like the anonymity that 2wT provided: without having to return to the clinic, they could heal in the privacy of their own homes. Men of diverse ages, languages, and locations responded actively to 2wT, suggesting that the intervention was received favorably across most adult male patients.  

2wT improves male engagement in care  

Whether it’s HIV-related care or general health services, in general, men tend to miss appointments, not follow clinical instructions, and are less proactive about seeking care. Engaging men in traditional healthcare settings is an ongoing challenge. 2wT telehealth approach gives men choice and agency over their healthcare, interacting with healthcare providers when and how they preferred. Men responded well to educational prompts with early care seeking, reducing concerns for delays in care. Utilizing digital health interventions, like 2wT, is promising to reduce barriers such as work priorities, perceptions of poor-quality services, and traditional clinical settings that often focus on maternal or child healthcare.