1. Mobile Phone Technology and Male Circumcision Programs Scaling-up male circumcision programmes in the Eastern and Southern Africa Region Arusha, Tanzania, 8 –10 June 2010 Amy Herman-Roloff Research Project Coordinator, UIC/NRHS

2. 1. Client Emergency Line Installed September, 2009 Installed September, 2009 Receive an average of four calls per week from recently circumcised men (per district) Receive an average of four calls per week from recently circumcised men (per district) After phone consultation, a clinical team is dispatched to a client’s residence an average of 2x/month for further evaluation After phone consultation, a clinical team is dispatched to a client’s residence an average of 2x/month for further evaluation Since employees receive extra pay for responding in-person to emergency calls outside of normal working hours, it is important to review the records of clients who were visited at home to ensure that a home visit was medically necessary Since employees receive extra pay for responding in-person to emergency calls outside of normal working hours, it is important to review the records of clients who were visited at home to ensure that a home visit was medically necessary

3. 2. Clinician Support Line To be launched June, 2010 To be launched June, 2010 Line will be staffed by MC trainers at the UNIM Research and Training Center in Kisumu Line will be staffed by MC trainers at the UNIM Research and Training Center in Kisumu Objectives: Objectives: ­ To provide MC technical information 24-hours/day to providers ­ To improve the safety of MC services ­ To serve as a feedback tool to improve the MC training curriculum Call information will be recorded on a form and reviewed by the training team every two weeks to ensure consistent, quality information is being disseminated Call information will be recorded on a form and reviewed by the training team every two weeks to ensure consistent, quality information is being disseminated After six months, a chart review will be conducted to assess the translation of “hotline” support into improved clinical care After six months, a chart review will be conducted to assess the translation of “hotline” support into improved clinical care

4. 3. SMS Study Title: Text messaging to improve adherence to post-operative clinic appointments and reduce early resumptions of sexual intercourse after adult male circumcision: a randomized controlled trial Title: Text messaging to improve adherence to post-operative clinic appointments and reduce early resumptions of sexual intercourse after adult male circumcision: a randomized controlled trial Study enrollment July-Sept., 2010 Study enrollment July-Sept., 2010 A randomized controlled trial in which recently circumcised men will be randomized to receive (clinicians are blinded): A randomized controlled trial in which recently circumcised men will be randomized to receive (clinicians are blinded): ­ Intervention – 16 context-sensitive text messages after MC in English, Kiswahili, or Dholuo (n=600) ­ Control – standard of care (n=600) Objectives: Objectives: ­ Primary objective 1: To determine the effect of text messages on attendance at the scheduled 7-day post-operative clinic visit ­ Primary objective 2: To determine the effect of text messages on the resumption of sexual activity before 42 days post-procedure ­ Secondary objective 1: To identify potential predictors of failure to attend the 7-day visit and the resumption of early sex SMS text messages will be sent using RapidSMS, an open-source platform created by Dimagi, Inc. SMS text messages will be sent using RapidSMS, an open-source platform created by Dimagi, Inc.

5. SMS Study Overview Eligibility: Eligibility: ­ 18+ years ­ Circumcised at study facility ­ Client owns a phone with SMS capability, and has the phone with him (to sign up for SMS service and verify number) ­ Gives informed consent to participate Data Collection: Data Collection: ­ Baseline questionnaire (factors that would promote/inhibit attendance for 7-day follow-up visit) ­ Chart abstraction – demographic information and 7-day follow-up visit ­ 42-day questionnaire about AEs and abstinence ­ A random sample of clients who did not report for their 7-day follow- up visit will be called to ascertain reasons why

6. A SMS is sent every day for the first week, and then about 1x/week through day 42. Each message costs about $0.15. SMS Messages