An evaluation of the national antiretroviral treatment (ART) programme in Cameroon gave us theopportunity to assess its impact on quality of care, equity, and unsafe sex.The cross-sectional survey (“EVAL”-ANRS 12 116) was conducted in 2006-2007 among a sample of3151 HIV-positive adults attending 27 HIV-services at the three levels of health caredecentralization (central/provincial/district). Multivariate two-level analyses were conducted toassess the impact of HIV-care decentralisation on quality of care, equity and unsafe sex.The main results showed that quality of care in district HIV services was as good as in central andprovincial HIV services and even better for some outcomes, such as ART adherence and mentalhealth related quality of life (HRQL). Some structural factors limiting quality of care have also beenidentified such as the lack of qualified human resources and difficulties with the supply ofantiretroviral drugs (ARVs). Prevailing inequities in access to care were found to be linked both tosocio-economic and structural factors. Regarding prevention behaviours, access to ART wasassociated with a lower risk of unsafe sex.Our results confirmed the feasibility of HIV care decentralization. However, long term sustainabilityurgently requires better integration of this HIV-targeted programme into comprehensive healthcare re