title: Text messaging to improve attendance at post-operative clinic visits after adult male circumcision for HIV prevention: a randomized controlled trial.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  BACKGROUND
  ClinicalTrials.govNCT01186575.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Odeny
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Tapia
authors.forename: Krista
authors.initials: K
authors.lastname: Yuhas
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000379:methods*; D006801:Humans; D007630:Kenya; D008297:Male; D010349:Patient Compliance; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D012044:Regression Analysis; D017010:Reminder Systems; D012107:Research Design; D012306:Risk; D060145:Text Messaging; D016896:Treatment Outcome