Approximately 33.2 million people worldwide suffer from HIV/AIDS, with 63% of cases in Sub-Saharan Africa. Uganda had one of the highest prevalence rates in Africa in the early 1990’s, but the prevalence of HIV/AIDS in the country has dramatically reduced to 5.4%. Even if the spread of HIV/AIDS in the country has decreased, the enormous challenge of managing the disease in approximately 1 million HIV positive individuals still exists. Growing global and local efforts have been devoted to increasing the supply of antiretroviral therapy (ART). However, even with free ART, patients are failing to adhere to medication because of socioeconomic barriers such lack of access to food and transportation costs to clinics. The aim of this study was to understand the extent to which socioeconomic versus patient behavioral barriers are responsible for non-adherence in patients receiving free ART. Self-reported pill count adherence and reasons for non-adherence were determined by interviewing a sample of 140 patients at four PEPFAR ART clinics in Kayunga. Pill count adherence measures were abstracted from patients’ medical charts.

Average self reported adherence was 99.7% ± 0.6 and 89 (63.6%) of patients reported 100% adherence for a 6 month time period. Pill count adherence measures revealed that 86.4% of the patients had adherence ≥ 95% in the past 6 months. The main reasons for non-adherence were being away from medication at dose time (29.4%) and forgetting to take pills (27.5%). Lack of access to food accounted for 11.7% and transportation costs accounted for 7.8% of nonadherence in patients interviewed. The main challenges to adherence reported by patients with 100% self reported adherence were lack of access to food (41.6%) and side effects (15.7%). Patients attending the more rural clinics of Galiraaya and Bbale were significantly less adherent to ART than patients at the district capital of Kayunga DH (OR = 0.046 and 0.156 respectively). This study suggests that where as these socioeconomic challenges to adherence are significant; they come second to patient behavior barriers such as being away from medication at dose’s time and forgetfulness in patients receiving free ART.