BACKGROUND:
Antiretroviral therapy is the cornerstone of HIV treatment, but its effectiveness depends heavily on consistent patient adherence to scheduled appointments. Rural regions, such as the Vhembe district in South Africa, face persistent structural, economic, and psychosocial challenges that hinder adherence to antiretroviral therapy and the continuity of care. This narrative review synthesizes evidence on the multifaceted barriers to antiretroviral therapy appointment adherence in rural settings and evaluates intervention strategies that have demonstrated success across sub-Saharan Africa. It emphasizes the relevance of these findings to the Vhembe district context.

METHODS:
The review draws on three key evidence sources: a doctoral study evaluating home delivery models for Antiretroviral therapy, a systematic review of interventions supporting treatment, and a meta-analysis of adherence among pregnant women using digital and educational tools. The selected studies were critically examined for their applicability to rural service delivery and adherence outcomes.

RESULTS:
The review identifies major adherence barriers, including poor transport infrastructure, high indirect costs, clinic overcrowding, limited refill durations, stigma, and the impact of public health emergencies. Strategies such as home delivery, multi-month dispensing, mHealth device reminders, and community-based support programs have been shown to effectively mitigate these challenges. Combined socio-structural interventions yield the most substantial improvements in adherence outcomes.

CONCLUSIONS:
Improving adherence to antiretroviral therapy appointments in Vhembe requires an integrated model tailored to local realities. Combining decentralized care, social support structures, mHealth solutions, and financial incentives offers a sustainable path forward. However, research gaps in implementation science, cost-effectiveness, and context-specific interventions must be addressed to scale these solutions effectively.