Thus, we expect that the use of NSP as a supplement in animal feed may be an appropriate approach to minimize the toxicity of FB1 to animals. Our study estimated that approximately one-fifth of ART patients met the WHO immunologic or clinical criteria for ART failure at 12 months. Pharmacy refill data, particularly the PDC adherence measure, had high informational value in predicting ART failure. In contrast, self-reported adherence measures were frequently missing and, when they were captured, they offered little value in discriminating patients who experienced ART failure. Male sex, higher CD4 level at baseline, and less time enrolled in care before initiating ART were also important predictors of ART failure. A risk score based on the baseline PDC measure together with these patient characteristics strongly discriminated patients at risk of ART failure. Whereas only 10.1% of patients in the lowest risk score grouping experienced ART failure, 28.7% in the highest risk score grouping did so. The risk grouping was robust in predicting failure up to 42 months following ART initiation, and also performed well in the context of missing baseline CD4 results. Our results confirm PDC to be a viable proxy for adherence. The relative completeness of pharmacy-based data on medication regimen types, dispense dates, and amounts of medication dispensed, and the low likelihood that patients sought medications from sources outside their primary facility, all support use of iSante´ pharmacy data to estimate ART adherence. Several additional patient characteristics enriched the prediction model by reflecting dimensions of adherence not captured in the PDC proxy measure. For example, patients with higher baseline CD4 may have been less motivated to consistently take the medication they had in their possession, based upon a better overall level of health. Patients with longer duration of pre-ART enrollment may have included those who are inherently likely to remain in care and comply with recommended care behaviors, while patients with brief duration of preART enrollment may have included patients with a mix of inherent tendencies toward compliance. Lower pre-ART duration has been identified as a risk INCB28060 1029712-80-8 factor for ART attrition in Haiti. The higher risk of ART failure we found among males is consistent with evidence of elevated ART attrition risk among males in Haiti and elsewhere in the Caribbean region. In a resource-limited setting like Haiti, our risk score has an important role to play in helping providers target patients for adherence support services before ART failure occurs. Such services could include in-depth counseling sessions with social workers or psychologists, adherence reminder phone calls or text messages, outreach visits by community health workers, or other supportive interventions. In the context of highly constrained human and material resources, it may not be possible to offer these interventions on a universal basis.