This study assesses the literature evidence on climate change risk, resilience, and adaptation measures used among rural farmers in East Africa. A systematic literature review was conducted comprising 30 papers from the Web of Science database published during 2000–2022. The results of the literature review showed that climate change risks have direct impacts on agricultural practices, limit rural farmers’ resilience, and exacerbate their food insecurity. The most prominent risks are increasingly shorter wet seasons and heat stress, which lead to droughts and food production losses. Responding to climate risks, farmers in East Africa adopt various adaptation strategies such as mixed- and inter-cropping, conservation tillage, early planting, crop diversification, etc. Also, this review summarizes the determinants of climate change adaptation strategy selection by farmers in East Africa, including age, gender, household size, economic status and household assets, landownership and livestock, education and training, etc. Overall, the choice of adaptation strategies to climate change is strongly determined by the gender of household heads, the results of gender as a determinant of adaptation differ greatly between different case studies. Although female-headed households (FHHs) tend to perceive changes in temperature more readily than male-headed households (MHHs), the latter are generally more likely to adopt different adaptation strategies. Despite the resilience and adaptation measures used by rural farmers in East Africa now, improved weather forecasting and early warning systems are needed as a better direction towards the future.