• Development of practical guidelines for implementing adherence management strategies. These should include guidelines for: continuous adherence counselling; bringing treatment closer to home; adoption of a family care model approach to ART; use of practical reminders; adherence case management; and the use of medication organizers.

• Consideration of the establishment of a transport voucher scheme for people who genuinely cannot afford the cost of transport to collect their medication.

• Adoption of a uniform adherence monitoring system at all facilities in Botswana, with simple and practical tools such as pill count register and the visual line one-month recall. These measures need to be validated and standardized. Data generated should be reviewed periodically in order to monitor the rate and trend of adherence to ART.

• Sustained community mobilization aimed at mitigating stigma and discrimination in an effort to create an environment in which people can disclose and take their ARVs without fear of discovery.

• Enforcement of appropriate legislation to protect the rights of people in employment to access to treatment without fear of discrimination. Efforts are also needed to sensitize people to their HIV-related rights in the workplace, including the establishment of toll-free lines to enable people to complain if their rights are violated.

• Development of programmes targeting men to inform them about HIV-related issues. This would help increase the enrolment of men in ART programmes, help them to better understand the HIV-related gender issues, and mobilize them to be protectors and supporters of women in the fight against HIV.

• Development of new tools to sustain and improve adherence rates and influence behavioural change. This includes using radio stations, TV stations and mobile phone operators to send periodic signals with jingles reminding people to take their medication.

• Continuous operational research on adherence.

• Development of interventions targeting men to help reduce the HIV-related consequences of alcohol abuse.

• Behavioural change interventions designed to modify the work and home- related barriers to adherence should be developed and evaluated. For example, patients could be given small medicine envelopes (commonly known as 'seed bags') to carry some of their medicines when they go to places where they do not want to be seen taking medicines from original containers (e.g. when visiting friends, going to funerals or to work).

• Acceptance of HIV status, disclosure and gender were found to be the main emerging themes in the qualitative data. Further studies are needed to explore these variables in greater depth.