Background: Global and Cameroonian efforts to expand ART through the “test-and-treat” approach have made progress, but challenges remain that threaten epidemic control. This study assesses how well the strategy is implemented in the South West Region of Cameroon.

Methods: A cross-sectional study was conducted in eleven health facilities involving 504 HIV-positive individuals on ART for at least six months. Data were collected via questionnaires and record review, then analyzed using SPSS, chi-square tests, and logistic regression to identify factors affecting 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), absence of mandatory pre-treatment tests (OR = 2.38, 95% CI: 1.219–4.662, p<0.05), and ease of accessing free services (OR = 3.12, 95% CI: 1.45–6.70, p<0.05) positively influenced adherence and viral suppression. Conversely, misconceptions that ART is temporary (OR = 0.52, 95% CI: 0.30–0.89, 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<0.05), payment of higher amounts (AOR = 0.02, 95% CI: 0.001–0.233, p<0.05), and good adherence levels (AOR = 3.75, 95% CI: 2.10–6.70, p<0.05) were independent factors associated with treatment outcomes.

Conclusion: The test-and-treat strategy shows promise with high viral suppression, but delays, poor adherence, misconceptions, and systemic issues hinder its effectiveness. Strengthening health systems, addressing social barriers, and improving patient education are essential to enhance ART uptake, adherence, and achieve epidemic control.

Keywords:  HIV/AIDS, Test-and-treat, ART initiation, adherence, Viral suppression