HIV and AIDS remains the major health and development challenge bedevilling Africa in general and Zimbabwe in particular, especially under a resource constrained environment as well as a myriad of other economically related impediments. Notwithstanding such challenges, treatment of HIV and AIDS through Antiretroviral therapy remains indispensible in the response to the pandemic that is ravaging all sectors of the society. As a rational response, Zimbabwe like other progressive nations has embarked on a scaled up Antiretroviral Therapy initiation programme whose aim is to improve the quality of life for people living with HIV and AIDS. In spite of this robust effort the programme is being haunted by a plethora of challenges, ranging from the shortages of trained health staff, cultural practices, social inequalities, depleted budgetary allocations inter alia. The effectiveness of ART is measured in its role in prolonging life and improving the quality life of people living with HIV and AIDS. It is against this background that the cohort studies become imperative in informing how the ART programme is making a difference by focussing on survival rates of patients initiated on ART.