Near perfect adherence to ART is required to prevent treatment failure in the individual and to prevent the spread of drug-resistant viruses. Factors that influence adherence to ART can be divided into factors related to the treatment regimen; social and psychological factors; institutional resources; and personal attributes.

The treatment regimen should be kept as simple as possible and be tailored to the patient's lifestyle. Untreated side effects are one of the strongest predictors of non-adherence. Mental disorders and drug/alcohol abuse should be addressed before initiating treatment. The patient's attitude towards medication and health beliefs could adversely influence adherence. The development of healthcare infrastructure should be a high priority and services should be patient orientated. Few personal attributes are consistently associated with adherence. Healthcare workers are poor at predicting adherence. The South African guidelines therefore focus on providing comprehensive adherence support to all patients.