- Failure to adhere to HIV treatment is costing lives
- The Ndovu Study is strengthening HIV treatment by redefining how treatment failure and drug resistance are detected, managed, and prevented across Africa and beyond.
Nairobi, KENYA (12 February 2026) — A new study is generating critical evidence to guide the optimal management of HIV patients who are failing treatment and developing resistance to the drug dolutegravir, offering hope to millions of HIV-positive individuals across Africa and worldwide.
HIV is treated through antiretroviral drugs that suppress the virus in the body, allowing people living with HIV to live long, healthy lives and prevent transmission. Today, most treatment regimens in Africa, including Kenya and around the world contain a drug called dolutegravir (DTG), which is the most important component of that treatment. When treatment is taken consistently, the amount of virus in the blood (viral load) drops to very low levels, protecting the immune system and preventing serious infections. However, people may experience treatment failure if they do not adhere to treatment, causing the viral load to rise. In some cases, the virus can also develop resistance to treatment, meaning the medicines no longer work effectively. Failure while on dolutegravir is concerning, as there are limited options available for treatment, putting people at risk of death.
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The Ndovu project is a large multi-country study being carried out in Kenya, Tanzania, Lesotho and Mozambique. The project is enrolling HIV infected individuals who have a high viral load and are on treatment with dolutegravir, indicating possible adherence difficulties or drug resistance.
Failure to adhere to HIV treatment is one of the major contributors to drug resistance, treatment failure, and risk of advanced disease (AIDS). With many countries using Dolutegravir (DTG)-based regimens as first-line HIV treatment, emerging data show that poor adherence to treatment leads to virological failure, often marked by dangerously low CD4 counts and life-threatening opportunistic infections such as tuberculosis, cryptococcal meningitis, and other severe infections.
The Ndovu Study is transforming how treatment failure is understood and managed by following patients closely, supporting them to adhere to treatment, creating an understanding of drug resistance through drug resistance testing, supporting the identification and management of advanced HIV disease and providing crucial data to aid in the development of national and international guidelines on the management of HIV treatment failure.
Despite major progress in HIV treatment, the global response remains at a critical crossroads. WHO estimates that in 2024, 40.8 million people were living with HIV, 1.3 million acquired HIV, and 630,000 died from HIV-related illnesses. This calls for the urgent need to revolutionise the quality of HIV care, adherence support and timely clinical decision-making.
From 26–28 January 2026, CEMA hosted Principal Investigators and partners for a three-day Ndovu Investigators’ Meeting in Naivasha, bringing together researchers from Kenya, Tanzania, Mozambique, and Lesotho, alongside representatives from Ministries of Health and implementing partners. The meeting reviewed progress achieved over the past year and aligned priorities for the next phase of the study.
Ndovu teams work closely with Ministries of Health and National HIV Programs in their respective countries to ensure that emerging evidence directly informs policy and clinical practice. While early findings are promising, there is still more to be accomplished with continued collaboration, learning, and rapid translation of evidence into action.
The Ndovu Study is sponsored by the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi, in collaboration with the Kenya Ministry of Health, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, Solidar Med in Lesotho, and Instituto Nacional de Saúde (INS) in Mozambique, and funded by the Bill & Melinda Gates Foundation.
With data, Ndovu is addressing treatment failure, resistance and adherence head-on, reshaping the future of HIV treatment—strengthening health systems, ensuring no patient is left behind and ultimately, saving lives.
Dr Loice Ombajo, Chief Investigator of the Ndovu Study, infectious disease specialist, and Co-Director at the Centre for Epidemiological Modelling and Analysis (CEMA), University of Nairobi, said, “It is deeply concerning that some people are experiencing treatment failure due to lack of adherence to therapy and potentially developing resistance to dolutegravir, placing their lives at risk. We urgently need evidence to guide how patients should be managed when they fail treatment and when drug resistance develops. Data from this study will help inform global guidelines on how to care for people living with HIV who do not respond to currently available treatment options.”
Dr Patricia Munseri, study Principal Investigator in Tanzania and Associate Professor and Head of Infectious Disease Unit in the Department of Internal Medicine at Muhimbili University of Health and Allied Sciences (MUHAS) said, “While we look forward to initiating the Ndovu clinical trial, we are confident in our ability to recruit and retain participants while being mindful to attain high-quality data that aligns with the study protocols, national and international ethical and regulatory standards and compliance with the aim of generating critical evidence to inform national and regional HIV treatment policies on how best to manage patients who are failing dolutegravir-based treatment.”
“We are indeed happy and proud to be associated with the Ndovu team, being an African-led project that brings together Researchers from other African countries. We do believe that this is an excellent opportunity for further collaboration within the continent and globally in addressing public health challenges.”
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Dr Irene Ayakaka, study Principal Investigator in Lesotho and Technical Director at SolidarMed, Lesotho, said, “Being part of the Ndovu study in Lesotho is a great privilege. The study is already demonstrating that sustaining the gains in HIV treatment—particularly in Africa—requires early detection of drug resistance and routine monitoring to prevent widespread treatment failure. Key lessons emerging from the study include the importance of strengthening laboratory systems, supporting adherence among people living with HIV, and aligning national policies with evolving evidence. These insights are shaping discussions at the highest levels and will directly inform national HIV treatment guidelines.”
Dr Nalia Ismael, Principal Investigator in Mozambique, said, “Ndovu study brings real-world cutting-edge data led by Africans researchers. Although substantial efforts have been made in Mozambique to strengthen HIV treatment care management, there are still gaps, especially with patient retention, adherence, and increasing HIV drug resistance.”
“We believe that the findings of this study will provide critical insights and guidance to the national HIV treatment program on how to better manage these patients, particularly in a scenario where patients are persistently failing DTG regimens. Our goal in collaboration with the Ministry of Health is to deliver real-time, high-quality data that will improve patient outcomes.”