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To assess adherence to HAART and to determine factors associated with poor adherence among HIV-1-infected patients in Abidjan, Côte d'Ivoire.A prospective observational study of 614 consecutive patients attending an HIV/AIDS outpatient clinic. Adherence was measured twice at 3-month intervals by self-report of missing doses over 4 days. An adherence level of less than 95% was defined as poor adherence. We used generalized estimating equation models for binomial distribution with repeated measures for data analysis.Of the 591 subjects who completed the study, 74.3% reported adherence levels of 95% or greater. Six factors were independently related to poor adherence: age less than 35 years [relative risk (RR) 1.45; 95% confidence interval (CI) 1.17–1.79], absence of social support (RR 1.66; 95% CI 1.24–2.24), number of daily pills 10 or more (RR 1.47; 95% CI 1.14–1.91), time of adherence assessment (first versus second time assessment RR 1.36; 95% CI 1.12–1.66), CD4 cell count of 250 cells/μl or greater (RR 1.43; 95% CI 1.10–1.88), and not being less worried about HIV infection now that treatments have improved (RR 1.26; 95% CI 1.01–1.58). Drug supply interruptions in the pharmacies were reported by 10.0% of the non-adherent patients as the reason for missing pills.Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Scaling up antiretroviral therapy in sub-Saharan Africa should be preceded by reliable drug supply and distribution systems.