Early motor inequities: how birth conditions and social context shape motor development in the first five years of life.

During the early stages of implementation, same-day anti-retroviral therapy (ART) initiation policies (i.e., ‘Treat All’ policies) were widely heralded as the key to an AIDS-free generation [–]. While global implementation of such guidelines have yielded improvements in early-stage HIV care continuum outcomes, specifically reducing the time from diagnosis to treatment initiation [, ], evidence is mixed regarding the impact of such guidelines on downstream care outcomes (e.g., sustained engagement in care) [, ]. Other policies and programs, such as multi-month ART prescribing, peer support or navigation, community-based medication pickup programs, or population-specific clinics, may be needed to achieve optimal retention and viral suppression over time [–]. Indeed, one study from South Africa showed retention in care one year following linkage among those diagnosed with HIV before and after implementation of same-day treatment initiation policies were similar, highlighting that same-day treatment initiation policies alone are insufficient for improving long-term outcomes and ultimately ending the HIV epidemic []. In much of Africa, estimates of ART use, retention in care, and viral suppression continue to lag behind global targets even in the era of same-day treatment initiation policies; this is particularly true in populations with comorbid health conditions [–]. In Cameroon specifically, while the incidence of HIV has declined steadily over the past two decades, from 1.8 per 1,000 population in 2010 to 0.5 per 1,000 population in 2024, just 82% of people (74% of men) living with HIV were virally suppressed in 2024 despite free treatment across all levels of the health system since implementation of Universal Test and Treat in 2016 []. Moreover, in a study comparing viral load across twelve sub-Saharan African countries, Cameroon had the highest mean log viral load for both males and females, suggesting significant progress remains to achieve optimal treatment outcomes in this setting specifically []. Same-day ART initiation care models presume patients are psychologically ready to start lifelong treatment at the time of diagnosis or entry into care with HIV []. However, in practice, many people newly diagnosed with HIV experience acute psychological distress (e.g., heightened depressive symptoms and, in severe cases, thoughts of death, self-injury, or suicide) in response to their diagnosis or other difficult life circumstances (e.g., loss of a parent) that are common among people with HIV, particularly in Africa [–]. Such feelings may impact an individual’s readiness to start ART, especially if they believe life is no longer worth living []. Indeed, evidence from the continent demonstrates that psychological distress at or soon after HIV diagnosis is common and consequential []. For example, in one study from Ethiopia, the odds of psychological distress were significantly higher among people initiating ART who were newly diagnosed with HIV compared to others and among those who initiated ART late compared to others []. Importantly, psychological distress at the point of entry into HIV care may also hinder sustained engagement in care and other downstream care continuum outcomes (e.g., viral suppression), even among those who initiate treatment the same day they are engaged in care [–].