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We examined the implementation of recommended strategies for adherence support and monitoring for adults with HIV through serial cross\u2010sectional structured surveys conducted by the International epidemiology Databases to Evaluate AIDS (IeDEA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used data from surveys completed by HIV clinics across 43 countries in 2017 (\n                      <jats:italic>n<\/jats:italic>\n                      = 206), 2020 (\n                      <jats:italic>n<\/jats:italic>\n                      = 200) and 2023 (\n                      <jats:italic>n<\/jats:italic>\n                      = 214); 131 clinics completed all three surveys. We used descriptive statistics to examine clinic resources and routine adherence support and monitoring at each time point, stratified by country income level (i.e. low\/middle\u2010income vs. high\u2010income countries [LMICs\/HICs]), and trends among clinics completing all three surveys. We created composite measures of the level or intensity of routine provision of adherence aids\/reminders, adherence support and adherence monitoring, ranging from \u201cnone\u201d to \u201cenhanced\u201d levels. Among clinics participating in the 2023 survey, we also examined adherence aids and support routinely provided to clients eligible for intensified support versus all clients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At each time point, surveyed clinics were predominantly in LMICs (68.4%\u221274.3%) and urban settings (65.0%\u221265.5%), situated within health centres (60.2%\u221264.0%) or regional\/provincial or university hospitals (28.0%\u221233.5%). Among 131 clinics participating in all surveys, there was a decrease in the provision of multiple adherence readiness counselling sessions from 52.2% of clinics reporting \u22652 sessions before treatment initiation in 2017 to 26.0% in 2023, along with increased provision of 6\u2010month ART refills (from 11.5% to 40.5%). The provision of \u201cenhanced\u201d levels of adherence support to all clients decreased from 2017 to 2023 in both LMICs (64.6% to 28.1%) and HICs (34.3% to 8.6%); in 2023, substantial proportions of clinics reported that such support was routinely provided only to clients eligible for intensive adherence support. At each time point, higher proportions of clinics in LMICs reported \u201cenhanced\u201d adherence monitoring than in HICs (63.5%\u221270.8% vs. 31.4%\u221254.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While streamlined provision of ART adherence support may reflect the implementation of guidelines recommending the targeting of support towards clients with known or suspected adherence challenges, further research should examine how evolving clinic adherence support practices are associated with care retention and virologic suppression outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70197","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:36:07Z","timestamp":1788503767000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolution of ART Medication Adherence Support and Monitoring Across IeDEA Sites: Results From Three Waves of Consortium\u2010Wide Site Assessment Surveys, 2017, 2020 and 2023"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8514-1958","authenticated-orcid":false,"given":"Ellen","family":"Brazier","sequence":"first","affiliation":[{"name":"Institute for Implementation Science in Population Health Graduate School of Public Health and Health Policy City University of New York  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"KEMRI\u2010CMR\u2010RCTP Lumumba Sub\u2010County Hospital Grounds  Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1741-335X","authenticated-orcid":false,"given":"Jessie K.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Epidemiology 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