 Participants will choose between two follow-up schedules: monthly every 4 weeks or monthly plus daily with directly observed therapy DOT. During DOT visits clinic staff will witness the participant swallow hisher study medication and clinic staff will initial the participants tenofovir adherence card. Monthly visits will be the same for both groups and will include an assessment of tenofovir adherence and adverse events, a pill count and collection of unused pills, provision of a new 1 month supply of study medication, pre- and post-test HIV counseling, rapid oral HIV testing, urine pregnancy test for female participants, HIV risk reduction counseling, and medication adherence counseling. At 3, 6, and every 3 months thereafter monthly procedures will be supplemented with a risk behavior questionnaire. 