Children and adolescents living with HIV (CALHIV) have a lifetime of antiretroviral therapy (ART) ahead of them. An estimated 95% of HIV service delivery is currently facility-based, largely undifferentiated for individual need. Differentiated service delivery (DSD) is a client-centred approach, simplifying and adapting services to better meet the needs of people living with HIV and reducing unnecessary burdens on the health care system. Differentiated ART delivery for clinically stable children and adolescents is supported by global agencies, and a growing body of evidence highlights how differentiated ART provides a significant opportunity to improve treatment adherence among children and adolescents living with HIV. However, CALHIV are still often not prioritized when scaling up differentiated ART delivery.