Background: IPC approaches are the backbone of VMMC demand, facilitating discussions and allowing men to address their unique concerns. Despite relative effectiveness of IPC, most men showing willingness to get circumcised do not get circumcised. Internal programmatic data shows one third of men reached with circumcision messages get circumcised. Most VMMC programs lack structured follow-up strategies for clients missing appointments.
A door-to-door mobilization model, which utilized Community Health Workers (CHWs) equipped with tablets to maximize follow-up, efficiency and effectiveness of contact with potential VMMC clients was implemented over six months in Lusaka.
Methods: Ten CHWs and one supervisor were trained and equipped with pre-configured tablets, given unique identifier codes and assigned to one geographical area.
At each household, CHWs electronically submitted client information and booked VMMC appointments through a custom-built application, which generated unique client numbers. These were used to track clients and ultimately for reconciling appointments. Automated reminder messages were sent to appropriate CHW a maximum three times for clients missing appointments.
Results: 70% (121/171) of booked clients were circumcised, 91% of these on first booking, and 9% after follow-up visits. 37% of clients booked through a CHW were circumcised the following day, while 15% were circumcised between 2 to 5 days later, and 19% took 6 to 75 days.
Most of circumcised clients were males between 15-29 years; unmarried (84%); attained a minimum of primary school level education (96%); and unemployed (70%). Clients most likely to go for circumcision after a day were those with tertiary education (50%); heads of households (45%); unmarried (48%); employed (43%); and aged 15-29 years (41%). Conversely, clients requiring more time to get circumcised were those with up to secondary level education only (26%), and aged less than 15 years (23%).
Of the 30% clients missing appointments, most never attended school (71%) and were below 15 years (40%).
Conclusions: An innovative IPC demand creation model using CHWs coupled with a mobile-based feedback mechanism is an effective approach for identifying characteristics of clients who access VMMC services in low resource settings; monitoring client referral success rates; and promoting timely and systematic follow-ups.

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