Coffee leaf rust (CLR, Hemileia vastatrix) is considered the most damaging coffee disease worldwide, causing reduced yields and even plant death. CLR was detected in Hawaii for the first time in 2020, and quickly spread across the state. We initiated a CLR monitoring program in Kona, West Hawaii Island, to track the spread of this new invasive disease across a broad elevational gradient. The goals of the program were to assist growers in the early detection of CLR, to characterize patterns of disease incidence across the region, and to collect information on farm agronomics, management practices, and costs to apply fungicides, all of which can be used to develop Integrated Pest Management (IPM) strategies for this pathogen. We monitored 30 coffee lots in Kona, located between 204 and 875 m elevation. Average CLR incidence remained below 4% early in the season and increased to 36% during harvest. We observed no significant difference in CLR incidence between low-, mid- and high-elevation farms. A significant reduction in the number of leaves per branch was observed at the end of the harvest season, and a significant negative correlation was found between the number of leaves per branch and maximum CLR severity. Mean disease incidence and mean severity were observed to have a significant positive correlation. Incidence increased above threshold levels (5%), despite most growers applying preventative fungicides 3–10 times throughout the season, suggesting that improved coverage and timing of applications is needed along with the addition of systemic fungicides. Our study provides the first insights into CLR disease patterns under the unique and variable conditions under which Hawaiian coffee is grown, and will aid in the development of IPM programs that can be used to sustain Hawaii’s coffee industry under this new threat.