Successful administration of ART requires the patient to adhere fully to the regimen. The introduction of ART needs a well functioning health system with adequately trained health professionals, laboratory support, constant supplies of drugs and social systems to assist patients’ adherence and prevent future treatment failures. The purpose of the study was to explore and describe the challenges experienced by non-governmental organisations with regards to the roll-out of ART, with an aim to facilitate strategy development to overcome the challenges and enhance the success of ART rollout. The findings revealed five broad areas of challenges namely; challenges related to sustainability, challenges related to adherence, challenges related to health systems, challenges related to stigma and challenges related to behavior. Of interest were the surge of whoonga and the infiltration of ART roll-out by crime and violence.