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This study explored adherence to HIV antiretroviral therapy (ART) in an open care clinic in the Mufindi District of Tanzania. We analyzed survey data from a convenience sample of 30 HIV-positive adults who received ART at no cost from the Mdabulo Care and Treatment Center. Respondents self-reported their ART adherence on a visual analogue scale from one to ten, with ten being “always taking the medication on time as directed.” Mean adherence was 8.9 ± 1.0, with seven respondents self-reporting perfect adherence. Respondents who did not perceive adequate social support or who used alcohol had a tendency towards decreased adherence, but this did not reach statistical significance (perceived social support: Cohen’s d = 1.41, p = 0.061; alcohol use: Cohen’s d = 0.66, p = 0.123). Participants with a more recent diagnosis of HIV started ART sooner than those diagnosed a decade ago (p < 0.001). These results highlight the success of the local open care clinic model in improving both access and adherence to ART. Open care clinics provide care for free or at a nominal cost to any person seeking care. Future studies involving larger populations in the Mufindi District of Tanzania are needed to validate how social support and alcohol use influence ART adherence.