The challenges facing the health system in India are likely to impact on life-long adherence for patients in the context of the rollout of ART. Smaller ART programs have been able to demonstrate good adherence rates, but the question remains if this can be achieved by large public sector ART programs. Most adherence researchers share the basic understanding that patients are adherent when they take their medications as prescribed by the health provider. An approach to adherence that combines both clinical and social knowledge- a biosocial approach- is likely to move us to a better understanding of adherence and how to improve adherence to ART. This study on ART adherence of HIV patients aims to gather and document information that could be used to improve services and program strategies for strengthening and maintaining adherence at ART rollout sites in Kolhapur district.