Conclusion
Evidence from two RCTs in Zimbabwe and South Africa demonstrate that this 2wT approach provides high-quality VMMC follow-up as compared to required in-person reviews and lowers overall VMMC program costs. Rural savings using 2wT offset nominal increased costs in urban areas. Additional 2wT associated improvements in care quality, supervision, and verification also likely leading to longer-term savings. The health sector should invest in 2wT. In the context of National VMMC targets of 350,000 to 500,000 VMMCs per annum, employing 2wT could dramatically reduce the number of in-person post-operative reviews, resulting in concrete efficiency gains and significant annual program savings. Investing these resources back into the VMMC program could further expand VMMC access, improve care quality, and advance VMMC program goals of safe, efficient, and effective VMMC scale-up.