Interventions
The in-person one-on-one counseling sessions, administered by a lay health-counselor in both intervention arms, were conducted in a private room at the clinic using an illustrated workbook. Before the trial, we adapted the workbook from a prior study (Booster sessions, tailored to participants’ drinking agreements and gender, occurred between the two in-person sessions, and were scripted in both intervention arms to check participants’ progress on meeting the drinking agreement, and to provide positive reinforcement when drinking limits were achieved, and encouragement to keep trying when they were not met. The booster calls also allowed for a revision of participants’ drinking goals. Technology arm participants were asked to choose between SMS and IVR for their booster delivery after both were demonstrated by the intervention counselor. The IVR boosters, recorded in the voices of the actual counselors, included simple yes/no responses to recorded questions and were included to account for the expected low literacy of some of the participants. The technology boosters also included the option to request a call back from a live counselor. The live call boosters were delivered every 3 weeks and the technology boosters were delivered twice weekly. Following the first in-person session, the counselors trained the participants in the technology arm on entering a personal identification number to obtain the messages and responding to the booster session questions, with repeated training as needed, and provided a toll-free phone line to contact study staff.The counsellors were Ugandan graduates of college and the Uganda Ministry of Health HIV counselor training. For this study, they received approximately 10 hours of training and monthly check-ins with a licensed clinical psychologist with experience in Motivational Interviewing (MI) and brief alcohol interventions (SWK). The training included readings on MI, review of the intervention workbook, and multiple structured role-plays of the intervention.