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The Universal Testing and Treatment (UTT) program aimed to improve human immunodeficiency virus (HIV) outcomes by initiating immediate antiretroviral therapy (ART). However, UTT faced challenges, including high attrition rates and loss to follow-up (LTFU), particularly in South Africa, where implementation has sometimes led to increased treatment discontinuation. This study investigated HIV UTT program uptake and LTFU rates among people living with HIV (PLWHIV) in Moretele Sub-district, South Africa. A quantitative, observational retrospective design evaluated UTT effectiveness in rural HIV care. Adult clients initiating ART between January 2020 and January 2022 across nine clinics in Moretele Sub-district were included. A random sample of 500 medical records was analyzed using Tier.net and DHIS software for record identification. Data analysis using STATA 18.0 included descriptive statistics, bivariate analysis, and logistic regression to identify factors influencing retention. Of 203 records analyzed, (30.8%) were aged 30–39, and 52.8% were female. Most clients were single (61.8%) and employed (51.6%). Same-day ART initiation was high (83.8%), yet 70% were LTFU, 25% transferred, 4.4% stopped treatment, and 0.6% died. Clients aged 30–39 had higher odds of LTFU (adjusted OR = 1.77; p=0.007). Gender, marital, and income status showed no significant association. While UTT enables rapid ART initiation, high LTFU rates, especially among younger, male, and employed individuals, hinder success. Strategies to improve retention should focus on same-day initiators and community engagement. This study highlights critical challenges in UTT implementation, emphasizing the need for targeted interventions to address LTFU and enhance retention in HIV care programs.

The human immunodeficiency virus (HIV) testing services (HTS) are as important as any other healthcare service; hence clients should be encouraged to use them. The Universal Testing and Treatment (UTT) initiative is one of the ways for improving HIV outcomes by commencing rapid antiretroviral medication (ART). An explorative-descriptive qualitative study was followed to understand the motivation for accepting and utilization of HTS through the UTT strategy. The study was conducted in three selected PHC facilities around North-West province, Bojanala district, Kgetleng sub-district. Data was analysed using thematic content with the support of NVivo 12 software. Four main themes with supporting sub-themes emerged. The study findings showed that the majority of participants were not knowledgeable about or aware of the strategy until they tested positive in their clinics. HTS are still underused as participants presented to the facilities only when seriously ill, had symptoms or were pregnant. Some participants accepted their status and treatment because they were already sick and had no choice but to take treatment. Despite the different emotions, others were able to accept their treatment and status. Some disclosed and received support from family, partners and friends, while others had not. Fear of stigmatisation when seen frequently at the clinic was also noted. This article's findings can influence policymakers involved in HIV testing and UTT methods.