<p>Overall, good adherence (≥95%) for all the five DSD models in the selected health facilites in Tororo District was optimal at 88.5%(CI 84.4-91.6), good adherence was universal (100%) for the three models Fast Track Drug Refill (FTDR), Community Drug Distribution Point (CDDP) and Community Client-Led ART Distribution. Poor adherence was found at 11.5%(CI 8.4-15.6) in Facility Based Individual Management (FBIM) and Facility Based Group Management (FBG). There was an association between adherence to ART and age, facility location, health status, ART regimen, and availability of treatment assistant. Adherence was significantly lower among participants aged 15-17 years cPR:0.94(0.85-0.98) and those on ABC/3TC/DTG treatment cPR: 0.81(0.67-0.97). Barriers included; stigma, discrimination, transport costs and distance to the facility. The health system barriers included; limited follow-up from the facility, long waiting hours, healthworker knowledge and training</p>