Introduction <p>HIV/AIDS remains a worldwide challenge, impacting populations across the globe, with a significant concentration in sub-Saharan Africa (SSA). The Southern African Development Community (SADC) region is the hardest hit, experiencing severe effects from the epidemic. Despite advances such as the availability of Antiretroviral Therapy (ART) and increased access to treatment, many people living with HIV (PLWH) still struggle to consistently adhere to their ART regimens.</p> Method <p>A scoping review was conducted based on the Arksey and O’Malley’s framework; and results were reported in accordance with PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published in the English language between 2014 and 2024. Key search terms included “HIV adherence,” “ART barriers,” and “sub-Saharan Africa” or “SADC.” After screening 3,729 titles and abstracts, 40 peer-reviewed studies were selected for thematic analysis.</p> Results <p>Adherence to ART across the region was influenced by socio-economic issues, including poverty, unemployment, and food insecurity. Personal factors were also reported, such as stress, depression, and alcohol use and forgetfulness. Furthermore, unresponsive health system barriers, such as long travel to healthcare facilities, were common among all SADC countries. Moreover, adherence to ART in the region was also hindered by cultural barriers, including stigma and discrimination.</p> Conclusion <p>The reported findings highlight the complex factors that hinder ART adherence in the SADC region. To improve ART adherence, this review emphasises the significance of integrated interventions that address mental health, economic empowerment, improved access to healthcare services, and enhanced treatment outcomes for people living with HIV/AIDS. This necessitates promoting a comprehensive approach to HIV care throughout the SADC member States.</p>