Background: The provision of food supplementation to food insecure patients initiating antiretroviral therapy may improve adherence to medications. Methods: A home-based adherence support program at 8 government clinics assessed patients for food insecurity. 4 clinics provided food supplementation and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio [MPR]), CD4, and weight gain outcomes among food insecure patients enrolled at the food clinics to those of controls. Results: Between May 1, 2004 and March 31, 2005, 636 food insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. 258 of 366 (70%) of patients in the food group achieved an MPR of 95% or greater versus 79 of 166 (48%) among controls (relative risk, RR=1.5; 95%CI:1.2-1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline WHO stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response. Conclusions: This analysis suggests that providing food to food insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.