Background
In sub-Saharan Africa (SSA), direct provider-to-client communication approaches, including 2-way texting (2wT) and telehealth, are being deployed in HIV prevention, treatment, and care services with promising results, to improve patient engagement in care, including adherence [Since 2007, voluntary medical male circumcision (VMMC) has been recognized by the Joint United Nations Programme on HIV/AIDS and World Health Organization (WHO) as a critical component of combination HIV prevention, reaching almost 30 million males in SSA by 2022 [Requiring postoperative visits for all males when the risk of AEs is low suggests program inefficiencies at scale, making VMMC an excellent candidate for digital health innovation. Therefore, in 2019, the International Training and Education Center for Health at the University of Washington conducted a randomized controlled trial (RCT) in Harare, Zimbabwe, to test 2-way texting (2wT)–based telehealth for postoperative follow-up after VMMC [In South Africa, with support from the PEPFAR, approximately 500,000 VMMCs are conducted annually as part of the National Department of Health (NDoH) HIV prevention efforts [