Limitation of the study
Complete blinding at any level (single, double, triple) was not achieved in this study since the PI provided care to all patients- both the intervention and control group. The PI was aware of the limits placed on the study by his involvement in these steps and placed due care on extraction of information from notes and in care of patients to ensure his personal biases did not interfere with the conduct of the study. Ideally additional personnel should be involved but the structure of the health services clinic did not allow for this. We acknowledge that this is a serious, but not fatal, shortcoming of the study.