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:

* 18-45 years of age
* English speaking

Exclusion Criteria:

* \<18 or \>45 years old
* Non-English speaking
B: Inclusion Criteria (female):

* HIV-positive pregnant women seeking ANC at a study site
* Up to 32 weeks gestation
* Own or have access to a mobile phone on which they can receive calls and SMS messages

Exclusion Criteria (female):

* HIV-positive pregnant women who have already initiated antiretroviral treatment

Inclusion Criteria (male):

* Referral by pregnant female partner
C: Inclusion Criteria:

* Women who are eligible and due for breast screening in West London.

Exclusion Criteria:

* Women who are not eligible for breast screening due to for example bilateral mastectomies.
* Women who have chosen to not have screening and have informed the screening centre or their GP.
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