Please select the eligibility criteria that correspond to the clinical trial below.
Title: Reducing Provider Workload While Preserving Patient Safety: A 2-Way Texting Intervention in Zimbabwe's Voluntary Medical Male Circumcision Program
Brief Summary: Voluntary medical male circumcision (VMMC) in sub-Saharan Africa is safe: the average rate of moderate and severe adverse events (AEs) at the country level is 0.8%, corresponding to 99% of men healing without incident. To reach the global target of 20 million by 2018, VMMC productivity needs to double in countries already plagued by severe healthcare worker shortages like Zimbabwe. The ZAZIC consortium partners with the Zimbabwe Ministry of Health and Child Care (MoHCC) and performed over 120,000 VMMCs. Current VMMC care in Zimbabwe requires in-person, follow-up visits at post-operative days 2,7, and 42. Over 95% adhere to multiple follow-up visits within 14 days of VMMC. ZAZIC's program has an overall AE rate of 0.4%; therefore, overstretched clinic staff conducted more than 200,000 unnecessary reviews for VMMC clients without complications. High mobile phone ownership, severe healthcare worker shortages, and rapid VMMC scale up make ZAZIC's VMMC program an ideal setting to test a mobile health (mHealth) intervention to reduce provider workload while safeguarding patient safety. Through an un-blinded, prospective, randomized, control trial (RCT) in high-volume facilities providing VMMC, ZAZIC will implement an interactive, two-way texting (2wT) intervention to identify men healing without complication, allowing them to decline routine in-person follow up visits. 2wT will simultaneously identify men with any sign of an adverse event, encouraging rapid in-person follow-up when an AE is suspected on any day, reducing unnecessary visits while maintaining quality care. We aim to 1) determine if 2wT can safely reduce VMMC follow-up visits; 2) estimate the cost savings associated with 2wT over routine VMMC follow-up; and 3) assess the acceptability and feasibility of 2wT for further scale-up. It is expected that this intervention with be as safe as routine care while providing distinct advantages in terms of efficiency, costs, and reduced healthcare worker burden. This approach is innovative as it focuses on using a low-cost mHealth intervention to reduce provider workload without deterioration in quality care. The success of this intervention could lead to adoption of this intervention at the national level, increasing efficiency of VMMC scale up and reducing burdens on providers and patients


Options:
A: Inclusion Criteria:

* aged \<25 years requesting OC as their primary method of contraception
* currently sexually active or anticipating sexual activity within the next 30 days
* owns cell phone with text messaging capability

Exclusion Criteria:

* contraindications to combined hormonal contraception per clinic protocol (e.g., hypertension)
* previous participation in this study
B: Inclusion Criteria:

1. be between the ages of 18 and 35 (inclusive);
2. have an unmet need for family planning;
3. live in the service catchment area;
4. demonstrate phone ownership;
5. opt-in to receiving calls and/or SMS messages from the study team;
6. demonstrate basic ability to operate study tablet; and
7. consent to participate in the study.

Exclusion Criteria:

1. outside of the age range;
2. no unmet need for family planning;
3. live outside the service catchment area;
4. not able to demonstrate ownership of basic phone capable of receiving/making phone calls and receiving/sending SMS messages;
5. does not agree to receive calls and/or SMS messages from the study team;
6. does not demonstrate basic ability to operate study tablet; or
7. does not consent to participate in the study
8. not pregnant or \<4 months postpartum
C: Inclusion Criteria:

* Using oral contraceptive pills (OCPs) for less than 1 month, or plan to initiate OCP use at their current visit
* Be willing to use OCPs that are on formulary for the duration of the study
* Having a personal mobile phone with text messaging capabilities
* Proficiency in English or Spanish
* Agreeing to surveys regarding demographics, pill adherence behavior and its influences
* If younger than 18, must be accompanied by a parent or legal guardian who can provide informed consent for research participation

Exclusion Criteria:

* Electing OCPs solely for non-contraceptive benefits only
* Interest in pregnancy within the next 12 months
* Inability to give informed consent
* Planning to move from the local area before study completion, and is unable to return for follow-up and return the electronic pill bottle
* Planning travel outside the cell phone networks of United States or Canada
* Being in a situation where receiving text messages to take a birth control pill may endanger the safety of the subject
D: Inclusion: For health care workers (Aim 3):

1. are employees posted at the site;
2. are at least 18 years of age or over;
3. provide health care services to patients as part of the VMMC programs; and
4. are able to provide written informed consent.

For VMMC clients (Aims 1): Eligibility criteria for VMMC clients are:

1. 18 years or older;
2. possession of own phone at enrollment;
3. provides contact details (phone, physical location);
4. receives surgical VMMC;
5. willing to follow MoHCC VMMC protocols;
6. willing to come in Day 14;
7. Able and willing to respond to a questionnaire administered by phone 42 days after circumcision.

Exclusion for Healthcare workers:

1. not willing to participate
2. not willing to be recorded

Exclusion for VMMC clients:

1. men without cell phones;
2. those who chose PrePex as PrePex requires a device-removal visit 7 days after placement and has distinctly different follow-up protocols;
3. men who have an inter-operative AE during routine VMMC will be withdrawn from the study as these men will have known, additional follow-up risks and mandatory in-person visits.

Answer: D