Mobile Health: A New Approach to Circumcision Care

For over twenty years, medical studies have shown that Voluntary Medical Male Circumcision (VMMC) is a safe and effective method to reduce the risk of HIV. The good news is that serious side effects from this procedure happen in less than 2% of cases. However, doctors still recommend that men go back for check-ups in person within two weeks after surgery. In South Africa, even though side effects are rare, men are required to make two follow-up trips to the clinic, which can be a hassle and might discourage some from getting circumcised.

#Enter Mobile Health

Here's where mobile health, or MHealth, comes in. This approach uses digital technology to help lessen the need for in-person visits for both patients and healthcare workers. mHealth can help busy healthcare systems while also reaching people in remote areas. Imagine being able to check in on your healing without having to sit in a stuffy waiting room!

Recent studies in Zimbabwe and South Africa have tested a new way of using Text Messages between men aged 15 and older and nurses after the circumcision. These tests showed that texting is safe, reduces the workload for follow-up care, and is cheaper compared to traditional visits. However, these studies were done in a controlled setting, so we still need to know what things would look like in everyday practice.

#Expanding the Study

To get more information, a group of researchers in South Africa set up a new study. They worked with several healthcare organizations to evaluate using the texting method (we’ll call it 2wT) in regular VMMC clinics. They set up the study in three districts: one in a city, one in a suburban area, and one in a rural community. The study unfolded in two phases: the first was focused on intense support and the second was about maintaining the system.

During the first phase, from January to October 2023, clinics received help from the research team, and the texting system was improved based on feedback. In the second phase, starting in January 2024, local teams took over to ensure that everything continued smoothly.

#Costs and MHealth

One big worry when it comes to mHealth programs is cost. Many previous programs in low- and middle-income countries failed because there weren't clear cost assessments. While we know that mHealth can help, we need a better understanding of what it will truly cost to use these programs in real life.

This is why they included a study on costs in their research. They aimed to find out how much the texting method costs to implement, how much additional help would be needed during busy periods, and how much money could be saved when comparing 2wT texting to traditional check-ups.

#Texting: A New Way to Follow Up

The 2wT technology allows clients to choose texting instead of going back to the clinic for check-ups. This system combines automated messages that educate clients and asks them to reply if they’re healing well. Texting helps clients get advice from nurses, who can reassure them and let them know if they need to come in for an in-person visit.

Clients don’t need fancy smartphones; any basic mobile phone can work with this system. The clinics manage the 2wT participants through an app on computers or tablets. Clients are enrolled, educated on how to use the system, and receive any needed follow-up care—all within regular VMMC clinics.

The dedicated nurse is the main point of contact for clients who choose the texting program. If a client doesn’t reply after three days, the nurse follows up by phone to ensure everything is okay. This system even includes prompts to help maintain quality care.

#The Study Design

The research team divided their study into two phases with the texting program. In the first phase, clinics received support from the 2wT team while also managing regular patients. Over a year, thousands of clients were involved, with many choosing to participate in the texting follow-up.

Among those who used texting after surgery, the rate of checking for side effects was higher than those who relied on traditional visits, which is great news for patient safety. On average, participants who used texting had more than two fewer visits to the clinic, saving them time and effort.

#Campaign Season and High Demand

In South Africa, certain times of the year are busier for VMMC clinics, especially when students are on break. During these periods, enrollment in the texting program often increased dramatically. The researchers noticed that when demand was high, it created extra work for the nurses, leading to delays in responding to patients.

During busy campaigns, the number of clients who didn’t reply to texts was higher compared to quieter times. This meant that the quality of care dipped. The researchers are planning to look closely at these busy periods to understand how to improve care.

#Costing Methodology

To figure out how much implementing texting costs, the researchers carefully tracked all expenses during the study. They included salaries, technology fees, and other related costs. They also wanted to see how much money could be saved by replacing in-person visits with texting.

#What Did They Find?

During the first phase, the additional cost per client for texting was about $9.53. This cost included both research-specific expenses and the regular costs of running the texting program. While the added costs may sound concerning, the benefits of fewer in-person visits and more safety checks could outweigh these expenses.

In busy months, however, some extra personnel felt necessary to maintain quality care. This would increase costs slightly but not significantly.

#Estimating Savings

The researchers looked at ways to determine if using texting instead of in-person visits could save money. They estimated that in a district with a high number of circumcisions, if 40% of clients opted for the texting system, it would only add a small cost per client. If more people participated, the savings would continue to grow.

Even with increased staffing costs during peak seasons, they determined that implementing the texting system could still be cost-neutral or even save money over time.

#Looking Forward

The results of this study showed that using a texting system for post-operative care could be a beneficial move. More men would be able to have their circumcision checked without the hassle of going back to the clinic. It could improve patient safety while making it easier for healthcare workers.

However, the study also highlighted some important lessons. First, the costs of staffing for mHealth programs matter. It's crucial to maintain enough staff to keep the quality of care high. Second, while texting reduces the need for in-person visits, it doesn’t completely eliminate the need for healthcare workers to check in on patient recovery.

#Conclusion

This research provides valuable information for health systems considering adopting mHealth solutions. It suggests that using a texting follow-up program for circumcision care can be a safe and cost-effective method.

As more health organizations consider using digital solutions, they can lean on studies like this one to guide their decisions. With the right systems in place, it’s possible to save time, reduce costs, and improve patient care, all while doing our best to keep men healthy and happy!

And who would have thought that a simple text could make such a difference? So, the next time someone tells you that texting is a waste of time, remind them that it might just save a life!