title: The Impact of SMS-Based Interventions on VMMC Uptake in Lusaka Province, Zambia: A Randomized Controlled Trial.
abstract: BACKGROUND
  Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heightening the need for effective VMMC demand generation strategies for HIV prevention.
  
  
  METHODS
  A 3-arm randomized controlled trial measured the impact of 2 short message service (SMS) campaigns on self-reported and verified VMMC uptake over 6 months in Lusaka Province. The study enrolled 2312 uncircumcised males aged 15-30 previously subscribed on Zambia U-Report, an existing SMS platform providing confidential, free counseling services relevant to HIV and other sexually transmitted infections. Participants in the "Conventional" campaign group received a standard package of messages promoting VMMC. Messages sent to the "Tailored" campaign group were targeted at participants' intention level to get circumcised. The control group had routine counselor access through SMS. Data were collected using SMS surveys, and verification of self-reported VMMC uptake used health facility client data.
  
  
  RESULTS
  Six-month self-reported VMMC uptake was 11.6%, 12.6%, and 10.4% in the Conventional, Tailored, and control arms, respectively; verified uptake was 1.8%, 1.1%, and 1.5%. Using multivariate logistic regression, the adjusted odds ratio of self-reported VMMC uptake was 1.17 (95% CI: 0.80 to 1.72) in the Conventional campaign arm compared with the control arm and 1.24 (95% CI: 0.84 to 1.81) in the Tailored campaign arm. The adjusted odds ratios of verified VMMC uptake in the Conventional and Tailored campaign arms were 1.34 (95% CI: 0.45 to 4.02) and 0.67 (95% CI: 0.20 to 2.23), respectively.
  
  
  CONCLUSIONS
  Neither SMS campaign had statistically significant impact on VMMC uptake compared with routine SMS counseling. Future research is necessary to fully understand the potential of SMS-based tools for VMMC demand creation.
authors.affiliation: *IDinsight, Lusaka, Zambia; †UNICEF , Regional Office, West and Central Africa Region, Dakar, Senegal; ‡CHAMP, Lusaka, Zambia; §Zambia Ministry of Community Development, Mother and Child Health, Lusaka, Zambia and UNICEF Zambia Office; M&E Unit, Lusaka, Zambia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Leiby
authors.forename: Alison
authors.initials: A
authors.lastname: Connor
authors.forename: Landry
authors.initials: L
authors.lastname: Tsague
authors.forename: Crispin
authors.initials: C
authors.lastname: Sapele
authors.forename: Albert
authors.initials: A
authors.lastname: Kaonga
authors.forename: Joshua
authors.initials: J
authors.lastname: Kakaire
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D060145:Text Messaging; D055815:Young Adult; D015024:Zambia