Strengths and limitations
Our study is the first analysis to provide a sex-stratified analysis on the efficacy of a mHealth-implemented ABC pathway, and will be particularly useful to inform sex-specific recommendations and guidance, especially given the urgent need for sex-disaggregated data in this scenario [Nonetheless, our study has some limitations. First, this was a post hoc analysis of a cluster-randomized trial and may lack statistical power for some of the outcomes investigated, and for the specific subgroups examined about which the trial was not originally powered. Second, there were some imbalances on the baseline characteristics in both males and females allocated to mAFA intervention vs. usual care. While this is compatible with the randomized cluster design of the trial, this may have contributed, at least partly, to the results observed. Third, we were unable to evaluate the role of the social determinants of health (SDOH) in determining the results observed. Further studies are required to evaluate the role of SDOH and the potential sex-based differences in this clinical context. Fourth, although we adjusted our analyses for several potential moderators, we cannot exclude the effect of unaccounted confounders on the findings observed.