TITLE:
The Effectiveness of the HIV Test-and-Treat Strategy in the South West Region of Cameroon: Results of a Cross-Sectional Study
AUTHORS:
Tankoh Marceline Fegen, Loveline Lum Niba, Tendongfor Nicholas
KEYWORDS:
HIV/AIDS, Test-and-Treat, Art Initiation, Adherence, Viral Suppression
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.15 No.3,
September
8,
2025
ABSTRACT: Background: Over the past two decades, global efforts to combat HIV/AIDS have led to significant advancements in the expansion of Antiretroviral Therapy (ART) access using the “test-and-treat” approach endorsed by WHO in 2016. Cameroon has implemented the test-and-treat. Despite these efforts, significant challenges affect access to ART and outcomes, threatening progress toward epidemic control. This study set out to evaluate the implementation fidelity of the test-and-treat strategy in the South West Region of Cameroon. Methods: A hospital-based cross-sectional study was conducted in eleven health facilities across eight districts in the South West Region of Cameroon. This involved 504 people living with HIV/AIDS (PLHIV) (aged 15 - 59 years who had been on ART for at least six months) selected through a multi-stage sampling technique. Data collection was done using a structured questionnaire and data extraction form. Data were analyzed using SPSS version 26.0. Associations between adherence, viral suppression, and determinants were analyzed using chi-square tests. In addition, logistic regression was used to identify the independent factors associated with treatment outcomes. Results: Of the 504 participants, the mean age was 39.7 years, with females constituting 71.3%. Only 22.4% of newly diagnosed patients were initiated on ART on the same day, while more than 67% were initiated within a period of six months, indicating suboptimal implementation of immediate treatment. Good ART adherence was 56.8% using the Visual Analogue Scale (VAS) and 79.8% by self-reporting. Results showed that viral suppression was achieved in 87.7% of the study participants. Bivariate analysis indicated that older age (OR = 1.45, 95% CI: 1.02 - 2.07, p 0.05), concerns about stigma (OR = 0.60, 95% CI: 0.36 - 0.99, p > 0.05), and systemic delays (OR = 0.45, 95% CI: 0.23 - 0.89, p > 0.05) impeded optimal treatment outcomes. Multivariate analysis revealed that absence of mandatory pre-treatment tests (AOR = 2.15, 95% CI: 1.10 - 4.20, p Conclusions: The test-and-treat strategy is promising. Despite high viral suppression rates, delays in ART initiation, poor adherence, misconceptions about lifelong treatment, and systemic setbacks highlight critical gaps that impede the effective implementation of the test-and-treat strategy and better treatment outcomes. Strengthening health system capacity, addressing social barriers, and enhancing patient education are vital to improving ART uptake, adherence, and viral suppression, as we strive to meet the 95-95-95 targets and achieve epidemic control.