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NCT04327271: 2wT_RSA

Two-way Texting for VMMC Follow-up in Republic of South Africa

Completed NA Results posted Last updated 27 January 2023
What this trial tests

NA trial testing Text-based VMMC follow-up in Voluntary Medical Male Circumcision in 1,093 participants. Completed in 24 March 2022.

Timeline
7 June 2021
Primary endpoint
3 February 2022
24 March 2022

Quick facts

Lead sponsorUniversity of Washington
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposehealth services research
Enrollment1,093
Start date7 June 2021
Primary completion3 February 2022
Estimated completion24 March 2022
Sites9 locations across South Africa

Drugs / interventions tested

Conditions studied

Sponsor

University of Washington

Who can join

Adults 18 to 75, any sex, with Voluntary Medical Male Circumcision. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Cumulative Percentage of Patients With an Adverse Event (AE) (Moderate or Severe) on or Before Day 14 Visit Primary · Any AE before, and including, up to 22 days post VMMC to allow for logistical issues delaying attendance of the Day 14 visit

AE rates are a global indicator of VMMC quality. This is a standard WHO and US PEPFAR government indicator as indicated in the attached reference material: PEPFAR's Best Practices for Voluntary Medical Male Circumcision Site Operations. Incidence of AEs before Day 14 will be extracted from routine VMMC data for both 2wT and control. Incident AEs on Day 14 will be identified, classified, and graded for severity using routine Ministry of Health protocols and recorded on routine VMMC AE forms. The investigators will compare cumulative rates of any moderate or severe AE on or before Day 14 between

GroupValue95% CI
Text-based VMMC Follow-up2.31.3 – 4.1
Routine VMMC Follow-up Care1.010.4 – 2.3
Number of Non-study In-person Visits Primary · Less than or equal to 42 days post-operative

To determine follow-up visit reduction, the investigators will compare the number of in- person visits for intervention and control using a t-test.

GroupValue95% CI
Text-based VMMC Follow-up0.22± 0.65
Routine VMMC Follow-up Care1.34± 0.85
Percent of Adverse Events (AE) Identified /on/ Day 14 Visit Secondary · AEs identified during Day 14 visits that occurred only in the window between post-operative days 13-22

Percentage of patients with an AE (moderate or severe) identified on the Day 14 in-person visit using AE definitions from: PEPFAR's Best Practices for Voluntary Medical Male Circumcision Site Operations

GroupValue95% CI
Text-based VMMC Follow-up0.200.03 – 1.2
Routine VMMC Follow-up Care0.90.4 – 2.3
Number VMMC-related Severe Adverse Events Over 22 Post-operative Days Secondary · Within 22 days post operative

The number of severe VMMC AEs over the first 22 post operative days. The definition of "severe" in this context is any wound requiring re-opening of the wound, such as adding new sutures, from here: PEPFAR's Best Practices for Voluntary Medical Male Circumcision Site Operations. These two severe AEs were bleeding, requiring additional compression and resuturing of the wound.

GroupValue95% CI
Text-based VMMC Follow-up2
Routine VMMC Follow-up Care0

Adverse events — posted to ClinicalTrials.gov

Time frame: 42 post-operative days. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Texting
Serious: 0/547 (0%)
Deaths: 1/547
Routine
Serious: 0/537 (0%)
Deaths: 0/537
Other adverse events (4 terms — click to expand)

ReactionSystemTextingRoutine
BleedingSurgical and medical procedures
InfectionSurgical and medical procedures
Wound disruptionSurgical and medical procedures
SwellingSurgical and medical procedures

Data from ClinicalTrials.gov NCT04327271 adverse events section.

Sponsor's own description

Voluntary medical male circumcision (alternatively abbreviated in the literature as VMMC or MC) is a critical HIV prevention intervention with global support for expansion across sub-Saharan Africa (SSA). MC is safe: routine programs in SSA report adverse event (AE) rates well under 2%. Nevertheless, global MC guidelines require one or more follow-up visits within 14 days for AE detection. Our prior research in Zimbabwe employed two-way texting (2wT) between patients and providers to focus follow-up on men with potential AEs, allowing men healing without complication to opt-out of routine post-operative visits. 2wT safely reduced client visits by 85%, suggesting that 2wT can make MC services dramatically more efficient while maintaining safety. In the Republic of South Africa (RSA), high-volume urban clinics, remote service delivery, and low AE identification threaten quality at scale. Across more than 500,000 annual MCs performed, up to 1 million multi-stage, unnecessary MC reviews are likely conducted. RSA pressure for MC expansion and severe health system constraints, combined with good cell coverage, suggest 2wT's impact would be significant for MC care quality and efficiency, especially in rural areas. A randomized control trial (RCT) will rigorously evaluate how 2wT improves AE ascertainment and follow-up efficiency in urban and rural clinics. We aim to conduct an RCT to determine how 2wT increases AE ascertainment while reducing workload in the RSA implementation context. While the overall protocol covers multiple components over a 5-year study, this registration is specific to the RCT, aim 1.

Publications & conference data

5 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Expanding the Evidence on the Safety and Efficiency of 2-Way Text Messaging-Based Telehealth for Voluntary Medical Male Circumcision Follow-up Compared With In-Person Reviews: Randomized Controlled Trial in Rural and Urban South Africa.
    Feldacker C, Pienaar J, Wasunna B, Ndebele F, et al · · 2023 · cited 15× · PMID 37159245 · DOI 10.2196/42111
  2. 'I understood the texting process well'. Participant perspectives on usability and acceptability of SMS-based telehealth follow-up after voluntary medical male circumcision in South Africa.
    Pienaar J, Day S, Setswe G, Wasunna B, et al · · 2023 · cited 12× · PMID 37654716 · DOI 10.1177/20552076231194924
  3. Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study.
    Day S, Ncube V, Maja L, Wasunna B, et al · · 2023 · cited 10× · PMID 36947127 · DOI 10.2196/44122
  4. Finding the balance between rigour and relevance: implementing adaptations to the implementation of a pragmatic randomised controlled trial of a two-way texting intervention for voluntary medical male circumcision in South Africa.
    Setswe G, Day S, Ndebele F, Pienaar J, et al · · 2025 · PMID 40295128 · DOI 10.1136/bmjopen-2024-091934
  5. RETRACTED: Finding balance between rigor and relevance: Implementing adaptations to a pragmatic randomized controlled trial (pRCT) of a two-way texting study for voluntary medical male circumcision in South Africa using the Framework for Reporting Adaptations and Modifications in
    Setswe G, Ndebele F, Pienaar J, Wasunna B, et al · · 2023 · DOI 10.21203/rs.3.rs-2731828/v1

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