Antiretroviral therapy adherence in Brazil Maria I.B. Nemes, Hera ´clito B. Carvalho and Maria F.M. Souza Objectives: This study evaluated the adherence to antiretroviral therapy (ART) in 322 Brazilian outpatient services located in seven states providing care to 87 000 patients (72%) under ART. Methods: A previous study classified the 322 health services into four levels of quality of care. Sixty of them were randomly chosen on the basis of these levels. A cross- section of 1972 patients under ART visiting these services was interviewed using a structured questionnaire. Patients who reported taking more than 95% of the pre- scribed antiretroviral pills in the past 3 days were considered adherent. The chi-square test was first used to compare the prevalence of non-adherence among two or more categories of variables. A chi-square test for linear trend was used for ordinal variables. Three multivariate models were applied using health services predictors, treatment predictors, and personal characteristics predictors. The predictors were fitted into logistic regression models using backward elimination procedures. Results: The adherence prevalence was 75% (95% confidence interval 73.08–76.95). The level of quality of care was not associated with non-adherence. The models showed the following predictors of non-adherence: related to health services: services with 100 patients or less and missed appointments; related to treatment: more complex regimens and a high number of pills; related to personal characteristics: under 2 years of formal education. Conclusion: The adherence prevalence was similar to the rates currently obtained in developed countries. However, services with few patients need to be carefully monitored to maintain high rates. Care planning that prioritizes patients at risk also needs to be improved. & 2004 Lippincott Williams & Wilkins AIDS 2004, 18 (suppl 3):S15–S20 Keywords: adherence, AIDS, anti-HIV agents therapeutic use, antiretroviral therapy, compliance Introduction Currently, 120 000 Brazilians receive antiretroviral therapy (ART) from 540 service sites throughout the country. Since 1998, the Qualiaids group has conducted evaluations of the Sexually Transmitted Disease/AIDS Brazilian Programme focusing on issues of quality of care and adherence [1–4]. The first year Brazilian study examining ART adher- ence was conducted in 27 health service sites and interviewed 1041 patients. It used 80% of the pre- scribed pills as the cut-off point for measuring adher- ence, and found an adherence prevalence rate of 69% among the patients studied [1–3]. This present study evaluated adherence to ART in 322 Brazilian outpatient sites that provided care to 87 000 patients (72% of all patients enrolled in the programme) in seven Brazilian states (Sa ˜o Paulo; Rio de Janeiro; Rio Grande do Sul; Mato Grosso do Sul; Ceara ´; Maranha ˜o; Para ´) in all five Brazilian regions (southeast, Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. From the Department of Preventive Medicine Medical School, University of Sa ˜o Paulo, Brazil. Qualiaids is a multidisciplinary group formed by professors and AIDS programme professionals that deals with research and training in AIDS programmes evaluation and monitoring. Correspondence to Professor Dr Maria Ines Battistella Nemes, Departamento de Medicina Preventiva da FMUSP – Brasil, Avenida Dr Arnaldo, 455 2 o . andar Cerqueira Cezar, Sa ˜o Paulo, Brasil CEP 01246-903. Tel: +55 11 3066 7078; fax: +55 11 3066 7444; e-mail: mibnemes@usp.br DOI: 10.1097/01.aids.0000131315.44902.59 ISSN 0269-9370 & 2004 Lippincott Williams & Wilkins S15