HIV antiretroviral treatment in sub-Saharan African and other resource-limited settings has become a global priority. While falling antiretroviral prices promise to improve access, unsubstantiated concerns regarding poor adherence by many leaders limits enthusiasm for treatment. There are currently no accepted approaches to measuring adherence to HIV antiretroviral therapy to characterize adherence or identify the predictors of adherence in resource poor settings. We propose to study the acceptability of several adherence measurement strategies: electronic pill cap monitoring, unannounced home pill count and structured patient self report in HIV+ people receiving combination antiretroviral therapy in Kampala, Uganda. We will conduct qualitative interviews regarding the acceptability of these techniques developed in HIV+ homeless and marginally housed people in San Francisco. We will then conduct a quantitative study of the feasibility and validity of these measures (modified by qualitative interviews findings) as assessed by their correspondence with HIV viral load. This will be a first and necessary step to identifying the distribution and predictors of adherence to HIV antiretroviral therapy in a resource poor setting.
