Our study underscores the critical importance of establishing a comprehensive therapeutic alliance between patients and clinicians to assess and address the various factors that influence a patient’s treatment adherence in developing countries where the second line of ART regimen is not readily available. These identified factors are amenable to health and behavioral intervention. For example, depressive symptoms should be recognized and treated in a timely way. A multidisciplinary approach is necessary to address psychological, social, and behavioral challenges. Based on our study findings and past lessons learned from past behavioral interventions in resource-poor developing countries (Simoni et al., 2008), we are currently mounting an intervention trial to examine the barriers and concerns around ART adherence within the district hospitals in northern and northeastern Thailand. The findings from this study will shed light on the design of future interventions and programs addressing the barriers and challenges around ART adherence in Thailand and other countries.