Principal Safety and Workload Findings
COMPLICATIONS
The study conclusively demonstrated that in South Africa, 2wT for VMMC follow-up is noninferior to in-person reviews for AE ascertainment, providing rigorous evidence in support of 2wT safety in routine settings. The 2wT approach also dramatically reduced in-person visits, allowing the clinical team to focus on, and care for, those with potential complications rather than conducting scheduled follow-ups for all men, demonstrating clear efficiency gains. Most 2wT participants interacted via 2wT and elected to heal independently at home rather than return for an in-person review. The South African 2wT RCT adhered to best practices in the monitoring and evaluation of digital health innovations [First, recent findings from usability testing among 2wT HCWs [The 2wT approach improved the quality of postoperative follow-up, as evidenced by consistent and correct AE identification, a standard indicator of quality VMMC postoperative care. Improvements are likely owing to both patient and provider engagement. In 2wT, 5 moderate AEs were identified on or before day 7, after the men were first triaged by the 2wT nurse. This early AE ascertainment suggests that direct 2wT communication between the nurse and the patient encouraged men to return promptly for review when needed. By contrast, 4 men in the control group arm were identified with AEs at the day 14 visit or later, suggesting that they may have delayed care, or not received care, in the absence of the study. This care-seeking behavior suggests that 2wT improves patient health literacy and care engagement, placing the responsibility for healthy healing into the patient's hands and shifting the power balance toward the individual rather than the formal health sector. Furthermore, within the study context, providers promptly documented AEs, including the cascade from potential AEs, through AE clinical management. Although AE ascertainment is a priority indicator of quality VMMC care [Similar to the findings from Zimbabwe that showed that 2wT improved efficiency and reduced costs [Despite these benefits, there are challenges to scaling 2wT successfully. First, digital literacy among HCWs remains low [