Beating HIV from day 1: strengthening same-day antiretroviral therapy in South Africa: challenges, realities, and the path forward

Same-day initiation of antiretroviral therapy (ART), known as same-day ART, has been endorsed by the World Health Organization since 2017 as a strategy to improve treatment coverage, reduce HIV transmission, and increase the survival of people living with HIV. This approach aims to minimize loss to follow-up (LTFU) and strengthen engagement in care, particularly in high-prevalence settings such as South Africa. This review aims to synthesize available data on the benefits, challenges, and impacts of same-day ART, with a particular focus on resource-limited settings. A literature review was conducted on published studies that addressed the effectiveness, adherence, retention in care, and clinical outcomes associated with same-day ART. The studies indicate that same-day ART is associated with a significant improvement in treatment initiation and reduced delays in therapy. However, its success depends on several factors, including patient acceptability, healthcare system capacity, and the quality of psychosocial support. Increased risks of long-term LTFU have also been reported among certain vulnerable populations. Same-day ART represents a major advancement in the fight against HIV, but its implementation requires a contextualized approach, adequate training of healthcare providers, and strengthened psychosocial support to ensure long-term retention in care.