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Antiretroviral treatment (ART) has converted a highly fatal HIV infection into a chronic condition that requires lifelong care. Within the past decade, worldwide access to ART has improved significantly, with almost 10 million people receiving ART by the end of 2012. In addition to its life-prolonging effects, ART can also reduce HIV transmission to uninfected people. In this new era of HIV treatment, the continued success of ART will depend on improving our understanding of when to initiate therapy, creating continuity of care, and ensuring high treatment adherence. Adherence is the extent to which a person uses a medication according to medical recommendations, inclusive of timing, dosing, and consistency. Arguably, adherence is the most critical factor in ensuring ART success, because without good adherence, treatment failure is likely, leading to avoidable HIV-related morbidity and mortality. Additionally, imperfect adherence increases the risk of developing resistant HIV strains and transmitting the virus to others. Because adherence behaviours and patterns can profoundly affect an individual’s treatment response and potentially narrow future therapeutic options, improving and sustaining ART adherence is a critical component and priority of public health efforts.