Many drug users living with HIV demonstrate inadequate levels of medication adherence, and are at high risk for disengaging from care. HIV positive drug users are at even higher risk of poor medication adherence and treatment dropout when living far from treatment centers. Rural residence is common in the U.S. South where rates of new HIV infections are disproportionately high, especially among ethnic minorities. While there are efficacious interventions to improve HIV treatment adherence, only a few have targeted drug users, and these have required patients to come into research clinics for adherence interventions. Transportation problems, poverty, isolation, and stigma are known barriers to accessing adherence support among rural drug users with HIV.Additionally, most adherence interventions aim to increase adherence, but come too late, unable to respond in real time to adherence lapses to help patients re-initiate appropriate medication use while remaining in their natural environments. There is a pressing need to develop tailored, scalable interventions that detect nonadherence episodes in real time and enhance adherence to HIV treatment immediately. Building interventions upon familiar, existing technology could extend their reach into communities of non-urban patients living with HIV, overcoming common barriers to care, and could ultimately be scaled up to help drug using HIV+ patients nationwide.