The purpose of the research was to identify the reasons for switching patients from first-line regimens to second-line regimens in the public healthcare setting in Gauteng Province. This study was an observational descriptive study. Randomly selected medical records for patients over 15 years old on second-line ART regimen attending public healthcare facilities in Gauteng’s five districts were reviewed to assess compliance with STGs, document the reasons for switching, and identify factors influencing the switch to second-line regimen.