South Africa has implemented one of the world’s largest antiretroviral treatment (ART) programmes, with nearly 80% of HIV-positive individuals undergoing treatment at the time of study. Sustaining adherence to prescribed treatment regimens over the long term however remains challenging. This study aimed to delineate factors influencing antiretroviral treatment adherence in rural clinics in KwaZulu-Natal, South Africa.

Utilising a descriptive qualitative research design, the study sampled 30 patients who had been on ART for longer than six months. Focus group interviews were conducted using a structured questionnaire in isiZulu. Data analysis employed manual thematic analysis.

Factors such as employment constraints, inadequate transport, unemployment, poverty, food insecurity, stigma, limited disclosure options, reliance on alternative therapies, subpar clinic documentation, service deficiencies, issues with centralised chronic medicines distribution and lack of support groups emerged as primary barriers hindering ART access.

Interventions addressing adherence challenges should operate at individual and healthcare delivery levels. Intensified counselling and enhanced healthcare system efficacy are essential for fostering improved ART adherence.