Nearly 20% of patients in our study population had no adherence assessment and counseling form completed. That these very patients tended to have lower adherence levels by pharmacybased refill data, indicates that providers seemed to be missing patients with high levels of need. When resources are constrained, using the information about which patients are at higher risk of ART failure could help to decrease the number of eventual cases of ART failure which are missed. In a hypothetical cohort of 1,000 ART patients of whom only half can be reached with intensive adherence support services, targeting these services to high risk patients would result in missing 40% fewer of these critical cases. Even if universal coverage with adherence support interventions is possible, knowing a patient’s risk grouping could still help providers customize their communication messages according to risk grouping. For example, counseling for a patient at lower risk could focus on reinforcing positive behaviors. For those at higher risk, counseling could focus on identifying and overcoming barriers to adherence and could include referrals to other intensive adherence support services. This type of targeted communication strategy is identified as a best practice in HIV adherence support. The first recommendation arising from our study is to use the validated risk scoring algorithm to program an automated provider alert within the iSante´ electronic medical record system. The alert could be used in either an active or passive manner. For an iSante´ alert to be successful, providers would need to receive training on how to interpret the alert and integrate its use within their care delivery processes. Well-designed electronic clinical alerts and reminders have been shown to improve quality of care and patient health outcomes. The second recommendation arising from our study is to drop routine, universal documentation of self-reported adherence measures by providers. Leveraging automated adherence estimates derived from pharmacy refill data would allow for more efficient use of health worker and patient time, eliminating the need for providers to collect and record self-reported adherence data for patients with already-strong adherence by pharmacy data. Pharmacy personnel, who were responsible for completing about half of the adherence assessments for patients in our study, could shift their attention toward assuring strong data quality in the pharmacy MK-1775 side effects dispense and refill data, as well as toward following up with patients who are late for pharmacy refills. Having providers ask patients about adherence levels and barriers could have value as a cue to favorable adherence behaviors among patients; so it is important to note that the recommendation is not to abandon these conversations but rather to drop universal data collection of the self-reported adherence measures. The use of automated claims databases is a widely-used method for obtaining information for use in epidemiological studies.