title: Effect of text messaging to deter early resumption of sexual activity after male circumcision for HIV prevention: a randomized controlled trial.
abstract: BACKGROUND
  Resumption of sex before complete wound healing after male circumcision may increase risk of postoperative surgical complications, and HIV acquisition and transmission. We aimed to determine the effect of text messaging to deter resumption of sex before 42 days postcircumcision.
  
  
  METHODS
  We conducted a randomized trial where men older than18 years who owned mobile phones and had just undergone circumcision were randomized to receive a series of text messages (n = 600) or usual care (n = 600). The primary outcome was self-reported resumption of sex before 42 days.
  
  
  RESULTS
  Sex before 42 days was reported by 139 of 491 (28.3%) men in the intervention group and 124 of 493 (25.2%) men in the control group [relative risk = 1.13, 95% confidence interval (CI): 0.91 to 1.38, P = 0.3]. Men were more likely to resume early if they were married or had a live-in sexual partner [adjusted relative risk (aRR) 1.57, 95% CI: 1.18 to 2.08, P < 0.01]; in the month before circumcision had 1 (aRR: 1.50, 95% CI: 1.07 to 2.12, P = 0.02) or more than 1 (aRR: 1.81, 95% CI: 1.24 to 2.66, P < 0.01) sexual partner(s); had primary school or lower education (aRR: 1.62, 95% CI: 1.33 to 1.97, P< 0.001); were employed (aRR: 1.35, 95% CI: 1.05 to 1.72, P = 0.02); or were 21-30 years old (aRR: 1.58, 95% CI: 1.01 to 2.47, P = 0.05), 31-40 years old (aRR: 1.91, 95% CI: 1.18 to 3.09, P < 0.01), or older than 40 years (aRR: 1.76, 95% CI: 1.04 to 2.97, P = 0.03) compared with younger than 21 years.
  
  
  CONCLUSIONS
  Text messaging as used in this trial did not reduce early resumption of sex after circumcision. We identified key risk factors for early resumption that need to be considered in circumcision programs.
authors.affiliation: *Department of Epidemiology, University of Washington, Seattle, WA; †Kenya Medical Research Institute (KEMRI), Nairobi, Kenya; ‡Chicago Developmental Center for AIDS Research, University of Illinois at Chicago; Departments of §Global Health; ‖Obstetrics and Gynecology; and ¶Psychology, University of Washington, Seattle, WA; #Center for AIDS and STD, University of Washington, Seattle, WA; and **Department of Medicine, University of Washington, Seattle, WA.
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: D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002944:Circumcision, Male; D015658:HIV Infections / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems; D012725:Sexual Behavior; D013530:Surgical Wound Infection / Q000517:prevention & control*; D060145:Text Messaging; D055815:Young Adult