Limitations
unhealthy alcohol
We were unable to provide cost-effectiveness because we did not find statistically significant effects in the main trial. The lack of efficacy in the trial may be because we included all persons with unhealthy alcohol use due to the dearth of mental health professionals in sub-Saharan Africa [In addition, this analysis did not address key utilization issues such as the ease of use of the different booster delivery methods or participant considerations, such as privacy of receiving live calls as compared to receiving SMS or IVR messages that required written or push-button responses. A further limitation of this work is that the intervention delivery occurred within the context of a research study that scaled up three different interventions. Thus, our personnel and infrastructure costs were higher than for a typical HIV clinic, but we also accrued savings by being able to share resources across the differing interventions. Lastly, we chose the frequency of the booster sessions based on prior literature and based on what we considered most likely in future interventions; as such, the increased costs of the technology-based boosters compared to the live calls were in part driven by the high frequency of the technology-based booster sessions.