Introduction
Voluntary medical male circumcision (VMMC) is one of the most successful biomedical prevention strategies to reduce HIV transmission risk [Mobile health (mHealth) is used to describe the practice of healthcare and public health supported by mobile communication devices such as cellphones. mHealth interventions are recognized as more cost-effective compared to conventional interventions and may help address persistent challenges of healthcare worker (HCW) shortages and client difficulty in accessing healthcare facilities [In 2018, the International Training and Education Center for Health (I-TECH) in the Department of Global Health at the University of Washington (UW) and technology partner, Medic, conducted a randomized control trial (RCT) among VMMC clients in routine VMMC clinics in Zimbabwe using a two-way texting (2wT) telehealth approach between clients and nurses. 2wT is an mHealth platform for conversational messaging between VMMC clinicians and clients, providing short messaging service (SMS) for post-operative telehealth care in lieu of scheduled, in-person visits. In Zimbabwe, and likely in other VMMC programs operating at scale, in-person, post-operative visits may be burdensome for patients and providers, leading to poor attendance [South Africa, with reported mobile-cellular subscriptions of 161.8 per 100 population in 2020 [Costing of HIV prevention interventions is gaining recognition for its importance in informing policy and scale-up. In recent reviews of costing research on HIV prevention interventions in sub-Saharan Africa, 38 out of 159 studies (24%) were conducted in South Africa [