{"doi":"10.1101/2023.02.08.23284877","title":"Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa","abstract":"Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.","journal":"medRxiv","year":2023,"id":394146,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9448,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1109160,"name":"Rachel Mukora","orcid":"0000-0003-4304-1729","position":1,"is_corresponding":false},{"id":1062752,"name":"Felex Ndebele","orcid":"0000-0002-7499-7486","position":2,"is_corresponding":false},{"id":1062751,"name":"Jacqueline Pienaar","orcid":"0000-0002-6252-4534","position":3,"is_corresponding":false},{"id":1063224,"name":"Calsile Khumalo","orcid":null,"position":4,"is_corresponding":false},{"id":1109161,"name":"Xinpeng Xu","orcid":"0000-0002-5829-9960","position":5,"is_corresponding":false},{"id":597212,"name":"Hannock Tweya","orcid":"0000-0002-8247-1273","position":6,"is_corresponding":false},{"id":1062754,"name":"Maria Sardini","orcid":"0009-0000-1170-6373","position":7,"is_corresponding":false},{"id":1062753,"name":"Sarah Day","orcid":"0000-0003-2165-3580","position":8,"is_corresponding":false},{"id":340478,"name":"Kenneth Sherr","orcid":"0000-0002-2963-0829","position":9,"is_corresponding":false},{"id":1062759,"name":"Geoffrey Setswe","orcid":"0000-0003-3646-0722","position":10,"is_corresponding":false},{"id":467848,"name":"Caryl Feldacker","orcid":"0000-0002-8152-6754","position":11,"is_corresponding":false},{"id":250834,"name":"Yanfang Su","orcid":"0000-0001-7557-8518","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:19:10.334330Z","pmid":"36798405","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}