Abstract
Abstract Background Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) remains a major global public health challenge, with an estimated 25.6 million people living with HIV and 380,000 AIDS-related deaths reported in 2022. Although antiretroviral therapy is highly effective in suppressing viral replication and improving survival, optimal adherence remains difficult to achieve across Sub-Saharan Africa. This review mapped existing evidence on barriers and facilitators influencing antiretroviral therapy adherence in the region. Methods This review was conducted in line with the Arksey and O’Malley framework and reported in accordance with the PRISMA-ScR. Peer-reviewed studies published between 2000 and 2024 were retrieved from PubMed, African Journals Online, Dimensions AI, CINAHL, and JSTOR. Studies reporting barriers and facilitators of antiretroviral therapy adherence in Sub-Saharan Africa were eligible for inclusion. Results A total of 61 studies were included in this review. Findings reported adherence levels ranged from 25.07% in Kenya to 87.1% in Uganda. Barriers to adherence included socioeconomic constraints such as financial hardship, competing work demands, and food insecurity; healthcare system challenges including limited access to antiretroviral therapy, service inefficiencies, and negative provider attitudes; and psychosocial and individual factors such as stigma, inadequate social support, forgetfulness, and complex treatment regimens. Facilitators consistently identified included strong family and community support, trust in the effectiveness of antiretroviral therapy, and improvements in healthcare infrastructure and service delivery. Conclusion Antiretroviral therapy adherence in Sub-Saharan Africa is shaped by interacting individual, social, and health system factors. The findings underscore the need for integrated, context-responsive strategies that strengthen health system performance, reduce socioeconomic vulnerability, and leverage family and community support structures. However, interpretation of the evidence is limited by restriction to English-language publications, heterogeneity in study designs and adherence measures, and the absence of formal quality appraisal, highlighting priorities for future research.