Limitations
Despite promising results for the validity of the HEART, our study has some limitations. Development and validation efforts for the HEART thus far have been concentrated around Johannesburg, South Africa, particularly within a clinical trial research setting and implemented by trained staff. Although results in this setting remain promising, further research is needed to determine how both the HEART overall and its scales function outside of this setting in a real-world environment in South Africa and other regions. It is important to note, though, that implementation of the HEART has been led by lay counselors, not clinical staff, providing evidence that its utility has not been limited to specialist clinical staff. Relatedly, future research will also explore the ability of the HEART to be self-administered, which will also be informative about its use and function in other settings.