This systematic review examines patient retention in antiretroviral therapy (ART) programs in sub-Saharan Africa. The study analyzed 32 publications reporting on 33 patient cohorts (74,192 patients) from 13 countries, with a weighted average follow-up period of 9.9 months. The findings indicate that 77.5% of patients were retained, with loss to follow-up and death accounting for 56% and 40% of attrition, respectively. Retention rates at 6, 12, and 24 months were 79.1%, 75.0%, and 61.6%, respectively. Sensitivity analyses suggest that retention rates could range from 24% to 77% over two years. The study highlights the need for better patient tracing procedures, understanding of loss to follow-up, and early ART initiation to improve retention and reduce mortality. The findings also emphasize the importance of learning from programs with high retention rates to enhance overall patient retention in ART programs.This systematic review examines patient retention in antiretroviral therapy (ART) programs in sub-Saharan Africa. The study analyzed 32 publications reporting on 33 patient cohorts (74,192 patients) from 13 countries, with a weighted average follow-up period of 9.9 months. The findings indicate that 77.5% of patients were retained, with loss to follow-up and death accounting for 56% and 40% of attrition, respectively. Retention rates at 6, 12, and 24 months were 79.1%, 75.0%, and 61.6%, respectively. Sensitivity analyses suggest that retention rates could range from 24% to 77% over two years. The study highlights the need for better patient tracing procedures, understanding of loss to follow-up, and early ART initiation to improve retention and reduce mortality. The findings also emphasize the importance of learning from programs with high retention rates to enhance overall patient retention in ART programs.