Background

Cameroon adopted and started implementing in 2016, the ‘universal test and treat’ (UTT) approach to accelerate progress towards the fast-track targets. UTT has shown inconsistent results elsewhere and has not yet been assessed in Cameroon. We aimed to evaluate the effectiveness of this novel approach on the quality of care and health outcomes of people living with HIV (PLWHIV).

Methods

A retrospective cohort design was conducted at The Regional Hospital of Nkongsamba, using routine clinical service delivery data to compare retention, viral load suppression, and opportunistic infection incidence rates between PLWHIV initiated on ART based on the “Universal Test and Treat” strategy and those initiated on ART based on the standard deferred approach. Chi-squared test and log-rank tests were used where appropriate to compare the rates between the pre-UTT and post-UTT eras.

Results

The uptake of UTT increased from 39.1% to 92.8% while baseline CD4 count testing reduced from 89.4% to 0.4% from 2016 to 2021 respectively. UTT was significantly associated with a shorter mean time to access ART (24.3 vs. 278.7 days, p<0.0001), higher retention (77.1% vs.51.4%, p<0.001), reduced median time to viral load testing (7.2 vs. 41.0 person-months, p<0.0001), higher rates of viral load suppression (90.4 vs. 21.7 per 1000 person-months, p<0.0001) but with higher incidence of opportunistic infections (7.2 vs. 2.0 per 1000 person-months, p<0.0001) than the deferred approach.

Conclusion

The study has indicated that uptake of UTT approach is high and has improved access to ART, retention, viral load access and viral load suppression but a higher incidence of opportunistic infections was observed with low uptake of baseline CD4 testing. Assessing the immune status and screening for OI before rapid ART initiation could better fine-tune the UTT approach.