The critical importance of adherence to the medication and the expected adverse reactions to ARVs as well as how to monitor patient adherence using pill counts. The volunteers were asked to make weekly visits to their patients. Each volunteer had on average 4–5 patients in order to keep the workload manageable. During the weekly visits, the volunteers performed a pill count and assessed the presence of clinical problems and adverse reactions. Volunteers were asked to refer the patient with clinical problems and/or adverse reactions to ARVs to the clinical officer at the health centre. At these visits the volunteers recorded data on their findings on standardized forms. Patients with medical conditions which required specialized treatment not available in the health centre were referred by the clinical officer to the regional hospital. On a monthly basis the volunteers obtained ARVs from the health centre and delivered these to patients. In addition, they provided information on HIV/AIDS prevention to their patients and distributed condoms. When patients were recruited, they were also asked to identify a family member/friend as their treatment supporter to provide daily support for treatment adherence. Patients and their treatment supporters were counseled together on important aspects of treatment including lifelong duration of treatment, possible adverse reactions of the drugs and the need for high adherence to the medication. Treatment supporters were asked to remind patients to take their medications and record these on a patient log that was provided by the study. The volunteer logs were entered into a Microsoft Access database. The motivation of the volunteers was based on the recognition and support they received from the health care program and the community. Basic supplies required for their work were provided, e.g. a bicycle, raincoats and gumboots. An annual volunteer appreciation day was organized with participation of the entire community and its leaders. The volunteers did not receive any cash payments. Monthly meetings of all volunteers were held with a volunteer administrator, where problems were discussed, solutions sought and where the report forms were delivered and checked by the administrator. The boots, raincoats and bicycles along with volunteer coordination, enrollment by a physician and support activities described above were the only external material inputs by the study, over and above the resources routinely available to this publicly funded clinic. The study also provided an emergency supply of ARVs and co-trimoxazole for stock outs. The hospital clinic was a busy outpatient HIV clinic with an average of 80–100 patients per day, where two physicians handled the initiation and the monthly follow-up of ART patients. In case a physician was not available, a clinical officer dealt with the routine follow-up. Our study results show that in rural western Uganda, ART can be delivered through a HC/NVP-BEZ235 community-based program using existing resources with treatment outcomes equivalent or marginally better than to those of the best-practice hospital in the district. This comparison hospital was part of a nationwide program through the Joint Clinical Research Centre and therefore represents high national standards of ART provision in Uganda. Our study findings demonstrate that a HC/community-based HIV treatment program can be a feasible, safe and effective option for increasing access to ART in rural areas. The positive results in our HC/community-based cohort are best explained as resulting from the support provided to the patients by volunteers, treatment supporters and the community at large.