Barriers to ART adherence in sub-Saharan Africa: a scoping review toward achieving UNAIDS 95-95-95 targets

Abstract

Introduction: With the 2025 UNAIDS 95-95-95 deadline upon us, significant gaps remain in achieving universal HIV care and treatment targets, particularly in Sub-Saharan Africa. Despite years of intensified global efforts, progress has lagged, partly driven by the multifaceted challenges of non-adherence to ART, shaped by social, economic, structural, and individual factors. These challenges have been compounded by the ever-changing landscape of global HIV funding, further undermining treatment outcomes. Addressing these interconnected barriers is essential to identify and implement targeted, evidence-based solutions.

Methods: To explore these challenges and potential interventions, a scoping review was conducted, searching through PubMed and Dimensions databases for peer-reviewed articles published from 2020 through February 2025. Eligible studies focused on barriers to ART adherence in adult men and women ≥ 18 years old living with HIV, aligning with the UNAIDS 95-95-95 framework in sub-Saharan Africa.

Results: Of the 4,928 articles screened, 21 were included in this scoping review. Although the search period was extended to February 2025, no eligible studies published in 2025 were identified. Barriers to ART adherence were multifaceted, spanning individual-level issues such as mental health issues and substance abuse; social barriers including stigma and intimate partner violence; and economic factors, including food insecurity, transport costs, and income instability. Structural barriers such as health system fragmentation, clinic accessibility, and drug stockouts were also common and often worsened by the COVID-19 pandemic, which disrupted service delivery and exacerbated socioeconomic vulnerabilities. While only peer-reviewed articles were included in the analysis, recent UNAIDS reports and reputable media sources, such as The Guardian, were referenced to contextualize the emerging impact of the 2025 HIV funding cuts, which have not yet been reflected in the academic literature.

Conclusion: Our findings emphasize the urgent need for targeted, multi-level interventions to address persistent economic, social, psychological, and policy barriers to ART adherence. A sustainable funding framework, combined with financial support, mental health services, and community-based care models, is crucial for improving retention and long-term adherence. These insights are essential for shaping policies, strengthening HIV service delivery, and sustaining momentum toward the 95-95-95 targets amid systematic challenges.

Keywords: 95-95-95 UNAIDS; ART adherence; HIV/AIDS; adult men and women; global HIV funding.

Figure 1

Map showing Sub-Saharan African countries included in the scoping review. The dots represent the countries featured in the review. *Ethiopia is included as an additional country due to significant disruptions to HIV services associated with the 2025 U.S. foreign aid freeze, as reported by UNAIDS and reputable media sources. Original image designed by Rocketpixel/Freepik (freepik.com).

Figure 2

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram illustrating the identification, screening, and inclusion of studies in the review.