Background: Through universal “test and treat approach” (UTT)  it is believed that HIV new infection and AIDS related death is reduced at community level and through time HIV can be eliminated. With this assumption the UTT program was implemented since 2016. However, the effect of this program in individual level in terms of patient survival and treatment outcome was not assessed in relation to the pre-existing defer treatment approach.

Objective: To assess the effect of UTT program on HIV treatment outcomes and patient survival among a cohort of adult HIV infected patients taking antiretroviral treatment in Gurage zone.

Methods: Institution based retrospective cohort study through record review of 8 year (2012-2019) cohort was conducted in facilities providing HIV care and treatment. Randomly selected 500 records were reviewed and the data was collected using standardized structured checklist by trained professionals. Data was cleaned, edited and entered by Epi info version 7 and analyzed by STATA. Cox model was built to estimate survival difference.

Results: A total of 500 patients were followed for 1632.6 person-year of observation. The overall incidence density rate (IDR) of death in the cohort was 3 per 100 Person-year. It was significantly higher for differed treatment program, which is 3.8 per 100 Person-year compared to 2.4 per 100 Person-year in UTT program with a p.value of 0.001. The relative risk of death among differed cases was 1.58 times than the UTT cases.  The cumulative probability of survival at the end of 1st, 2nd, 3rd, and 4th years was 98%, 90.2%, 89.2% and 88% respectively with difference between groups, while the median survival time was 3.27(95%CI: 3.15-3.39) years among UTT programs and 3 (95% CI: 2.8-3.12) years in the differed treatment program. Patients enrolled in the UTT program survive longer than clients enrolled in the differed treatment program (Log Rank X² test =4.1, p.value=0.04). Age, residence, base line CD4 count, program of enrolment, development of new OIS and treatment failure were predicted mortality from HIV infection.

Conclusion: Mortality was significantly reduced after UTT. Therefore, intervention to further reduce deaths has to focus on facilitating the UTT program to initiate treatment as early as possible.

Key words: Universal test and treat, differed treatment, patient survival, HIV treatment outcome