Despite improved outcomes for children living with HIV in sub-Saharan Africa, major disparities still exist between low-income and high-income countries. In The Lancet HIV, Victoria Iyun and colleagues 1 Iyun Victoria Technau Karl-Gunter Vinikoor Michael et al. Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006–17): a retrospective cohort study. Lancet HIV. 2021; (published online April 28.) report results of a retrospective analysis on variations in characteristics and outcomes in children living with HIV who were younger than 5 years at antiretroviral therapy (ART) initiation following universal ART roll-out in 16 low-income, lower-middle income, and upper-middle income countries in sub-Saharan Africa between 2006 and 2017. The investigators analysed ART initiation characteristics, mortality, and loss to follow-up across 3 calendar time periods and identified risk factors for mortality in children initiated on ART.