We therefore hypothesized that most early deaths were occurring despite high levels of adherence and, potentially, virologic response. To investigate this further, we evaluated the relationship between the earliest routinely available objective measure of early ART adherence and risk of early adverse outcomes after ART initiation in a sub-Saharan African setting. Goals of our analysis were to include patients who suffered events very early after ART initiation in order to obtain a range of risk estimates within which the true relationship between early adherence and early outcomes is likely to exist,DCMU to estimate the proportion of early events in the population potentially attributable to suboptimal early adherence, and to describe virologic responses among those suffering early adverse outcomes.This prospective observational cohort study evaluated the relationship between early suboptimal adherence and early adverse outcomes among ART-naive, HIV-infected adults aged 18 years and older initiating free ART at the Infectious Disease Care Center at Princess Marina Hospital in Gaborone, Botswana. The IDCC at PMH is a large public HIV clinic where HIV-infected individuals with CD4 counts,200 cells/mm3 or a qualifying opportunistic illness were provided with free ART. Patients saw medical doctors with training in HIV care, including diagnosis and treatment of OIs. Initial ART regimens recommended as first-line therapy were fixed-dose combination zidovudine-lamivudine plus either efavirenz or nevirapine, although other ART medications were available. ART was dispensed on-site. Guidelines recommended HIV-1 RNA levels at baseline,Thapsigargin 3 months and then every 6 months thereafter. All care was provided free of charge. Early adherence was determined using pill counts performed by study staff at the time of initiation and first ART refill, given data indicating that pharmacy adherence measures such as pill counts consistently predict outcomes and are more accurate than self-report. Specifically, the number of days of ART dispensed to the patient at the time of starting ART was calculated using the prescribed daily dose and the number of pills of a single index ART medication in the regimen.