Community Health Toolkit

Two-way texting for male circumcision follow-up

Hi all!

I just wanted to send around a quick recap of the randomized control trial (RCT) that I recently completed in Zimbabwe with Medic Mobile (@isaacholeman @philip @korir @simon ) The NIH-funded study (R21) sought to use two-way texting (2wT) instead of in-person follow-up visits for male circumcision (MC) clients – testing whether it was as safe with workload and cost advantages. We now published all the findings from that study (trial protocol available here). First, we found that 2wT-based follow-up for post operative care was as safe as routine in-person follow-up for MC clients with clear workload savings for providers. We further found that 2wT was highly usable and acceptable for MC clients and providers. Lastly, we found clear cost advantages of 2wT over routine in-patient visits – costs that would incentive national scale-up and provide sizable benefits at scale.

Due to these significant benefits, the NIH recently awarded us an RO1 to implement another 2wT RCT and scale-up effort in South Africa’s MC program – this time using an implementation science approach. We will be partnering with Aurum Institute in South Africa on the 5-year study starting in July, 2020. I will post updates from those results as well.

Contact me for more details. I would be happy to talk about how we can expand and build on these experiences!


Thanks for sharing these details @cfeld ! I wanted to revive this thread with some more notes from a product perspective.

Some of the very earliest CHT deployments were focused on messaging for care coordination, and messaging continues to play an important role in many CHT deployments. For many years though CHT-Core didn’t support fully automated, interactive or bidirectional/two-way messaging “flows”. The study Caryl led in Zimbabwe starting in 2016 was the first to pilot this kind of messaging flow, in a way that is fully integrated with a CHT app used on laptops by nurses at a community health clinic.

Moving forward with the RO1 work in South Africa, we’ve improved upon the initial prototype by building an integration with RapidPro, which is a powerful tool for supporting this kind of messaging flows. It also works across multiple channels, for example WhatsApp or Telegram in addition to SMS. More organizations are already leveraging this integration, for example Living Goods and Medic are using it to support a Client Initiated Health Assessment study with ThinkMD and Praekelt in Kenya. If you want to read more about how the CHT-RapidPro integration works, there’s a RapidPro page on the CHT docs site.