Background: HIV prevalence among key populations (KPs) ranges from 10% to 30%. Community-based antiretroviral therapy initiation (INIC) is a differentiated service delivery strategy aimed at reducing barriers to early HIV treatment among KPs. This study assessed its acceptability and estimated its causal effect on same-day ART initiation, viral suppression after at least 12 months, and quality of life among KPs in Cameroon.
Method
We conducted an ethical approved quasi-experimental post-test-only study (February 2024–November 2025) in Yaoundé and Douala among 6 community-based organizations. Study included 299 HIV-positive key populations. INIC (intervention) was delivered by trained Health Community Workers following HIV testing in community settings (3 CBOs), while the reference group was referred to health facilities for ART initiation. Data were collected from questionnaires, clinical records, viral load testing, and the WHOQOL-HIV BREF. Causal effects were estimated using propensity score overlap weighting, with robust Poisson and Gamma regression models. Sensitivity analyses were done using propensity score matching 1:1.
Result
Four out of five [86.4% (95%CI: 80,2%–91,3%)] participants opting for INIC. INIC significantly increased the likelihood of same-day ART initiation compared with facility-based care (RR ≈ 1.5). After at least 12 months of treatment, viral suppression was similar between INIC and Hand Check strategies (RR = 0.96; 95% CI: 0.89–1.04), with an overall suppression rate of 96%. The WHOQOL-HIV BREF dimension showed acceptable internal consistency (McDonald’s omega: 0.56–0.69) and range from moderate (10/20) to high (14/20). INIC was associated with higher autonomy (+14%) and environmental health scores (+13%), but lower social relationship scores (−15%), while no significant differences were observed in physical, psychological, or spiritual domains.
Conclusions:
INIC reinforces decentralised service delivery and contributes to epidemic control. Nonetheless, lower social relationship scores point to the importance of integrating psychosocial support and strengthening community–facility linkages to improve quality of life and long-term sustainability despite the suspension of U.S. funding.