Limitations and Strengths
This study included participants receiving clinical care in a medical centre in rural Limpopo, South Africa. Therefore, findings from this study may not be generalizable to other rural settings in South Africa, or to other country settings. While the study assessed a broad range of psychosocial factors, the many individual, social and structural factors that may be of influence cannot feasibly be assessed in a single study. Therefore, the scope of covariates, while broad, by definition, and inevitably is limited. Potential covariates of ART adherence were assessed through self-report, which may have been affected by memory bias and social desirability bias. This study also highlights the practical limitations of conducting pill counts. In many cases patients forgot to take their left-over medication to their clinical visit. Previous studies used unannounced pill count to avoid this practical limitation, but this may not be feasible in practice.