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Infectious Diseases - Non-Clinical Medicine - Public Health and Epidemiology - Urology

Text Messaging to Improve Attendance at Post-Operative Clinic Visits after Adult Male Circumcision for HIV Prevention: A Randomized Controlled Trial
Published: Wednesday, September 05, 2012
Author: Thomas A. Odeny et al.

by Thomas A. Odeny, Robert C. Bailey, Elizabeth A. Bukusi, Jane M. Simoni, Kenneth A. Tapia, Krista Yuhas, King K. Holmes, R. Scott McClelland


Following male circumcision for HIV prevention, a high proportion of men fail to return for their scheduled seven-day post-operative visit. We evaluated the effect of short message service (SMS) text messages on attendance at this important visit.


We enrolled 1200 participants >18 years old in a two-arm, parallel, randomized controlled trial at 12 sites in Nyanza province, Kenya. Participants received daily SMS text messages for seven days (n?=?600) or usual care (n?=?600). The primary outcome was attendance at the scheduled seven-day post-operative visit. The primary analysis was by intention-to-treat.

Principal Findings

Of participants receiving SMS, 387/592 (65.4%) returned, compared to 356/596 (59.7%) in the control group (relative risk [RR]?=?1.09, 95% confidence interval [CI] 1.00–1.20; p?=?0.04). Men who paid more than US$1.25 to travel to clinic were at higher risk for failure to return compared to those who spent =US$1.25 (adjusted relative risk [aRR] 1.35, 95% CI 1.15–1.58; p<0.001). Men with secondary or higher education had a lower risk of failure to return compared to those with primary or less education (aRR 0.87, 95% CI 0.74–1.01; p?=?0.07).


Text messaging resulted in a modest improvement in attendance at the 7-day post-operative clinic visit following adult male circumcision. Factors associated with failure to return were mainly structural, and included transportation costs and low educational level.

Trial Registration NCT01186575