OBJECTIVES: Despite significant advancements in antiretroviral therapy (ART), long-term consistent adherence to therapy remains a challenge for many persons living with HIV (PLWH). Pharmacists are well-positioned to promote adherence to ART beyond mandated dispensing services, but face many barriers, including non-reimbursement for adherence promotion activities (APA). Our study examines the extent to which pharmacists’ barriers (e.g., inadequate staff, no space) influence the level of APA in different pharmacy settings. METHODS: We test the hypothesis that pharmacists with fewer barriers provide fewer APA to PLWH, using generalized linear modelling (GLM). We use factor analysis to generate the APA index based on 38 APA (e.g., adherence assessment, customized interventions, monitoring activities). RESULTS: We surveyed 225 pharmacists from 41 U.S. states: (22% North East; 23% Midwest; 28% West; 27% South). The sample was mostly female (63%) Caucasian (66%), and >30 years (67%). Most pharmacists had a HIV certification (68%); 31% worked in specialty-only and 21% in traditional-only pharmacies. Only 26% of pharmacists reported APA-related reimbursements. Despite most pharmacists (95%) reporting >5 barriers, the barriers index odds ratio (OR) was insignificant (OR: 1.007; p<.774). Insurance status [public vs. none (OR: 1.76 (p<.002) & private vs. none (OR: 1.90 p<.004)], pharmacy type [specialty vs. traditional (OR: 2.24 p<0.001)] and HIV certification vs. none (OR: 3.65; p<.001) were significant predictors of APA. Interestingly, the OR of high volume (>500 scripts/day) was significant only at 10% level (OR: 0.73 p<.07). CONCLUSIONS: The choice of pharmacy largely determines PLWH access to adherence promotion services from certified pharmacists. Our finding that pharmacies that invest in HIV certification training are more likely to have higher levels of APA has implications for third party payers interested in adherence promotion as a cost containment strategy. Despite lack of reimbursement for adherence promotion, many pharmacists are providing these important services to PLWH.