University of Illinois at Chicago
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Text Messaging to Improve Attendance at Post- Operative Clinic Visits after Adult Male Circumcision for HIV Prevention: A Randomized Controlled Trial

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posted on 2013-12-03, 00:00 authored by Thomas A. Odeny, Robert C. Bailey, Elizabeth A. Bukusi, Jane M. Simoni, Kenneth A. Tapia, Krista Yuhas, King K. Holmes, R. Scott McClelland
Background: 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. Methodology: 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-totreat. 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). Conclusions: 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.


This study was funded by the University of Washington International AIDS Research and Training Program, which is supported by the Fogarty International Center (NIH 5D43-TW000007). Additional support for the trial was provided by the Department of Epidemiology and Biostatistics at the University of Illinois at Chicago; and the Biostatistics and International Cores of the University of Washington Center for AIDS Research, an NIH funded program (P30 AI027757) which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA).


Publisher Statement

© 2012 Odeny et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The original version is available through Public Library of Science at DOI: 10.1371/journal.pone.0043832


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