Nairobi — New HIV research presented this week at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) has revealed critical evidence gaps that experts say must be urgently addressed to strengthen HIV treatment strategies across Africa.
Researchers from the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi presented findings from the Ndovu and Sungura studies, which examined treatment outcomes among children, adults with persistent viraemia, and older people living with HIV who are on dolutegravir (DTG)-based regimens.
The studies highlight the urgent need for locally generated, context-specific data to guide HIV treatment policies and clinical decision-making in African settings.
One Ndovu study focused on children and adolescents experiencing persistent viraemia–the continued presence of HIV in the blood–despite adherence counselling. Paediatric DTG formulations, introduced in sub-Saharan Africa in 2019, had initially offered hope for improved outcomes.
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However, findings from a large Kenyan cohort showed that 41 per cent of children and adolescents with high viral loads while on DTG failed to achieve viral suppression after three months, even after enhanced adherence counselling.
The researchers said the findings expose a major evidence gap in identifying effective interventions for young patients experiencing DTG treatment failure.
A second Ndovu analysis examined adults with persistent viraemia on DTG-based regimens and found that many patients with two consecutive high viral load results were still able to achieve viral suppression without switching treatment.
Current guidance from the World Health Organization (WHO) recommends switching to a protease inhibitor (PI)-based regimen after two high viral load results on DTG in the absence of drug resistance testing–a policy widely adopted in resource-limited settings.
However, the Ndovu findings suggest such recommendations could result in unnecessary treatment switches, given the limited supporting evidence and the possibility that some patients can re-suppress the virus with adherence support alone.
Meanwhile, the 96-week, open-label Sungura study evaluated the safety and effectiveness of switching adults aged 60 years and older from B/F/TAF (Bictegravir/Emtricitabine/Tenofovir Alafenamide) to DTG/3TC dual therapy.
At week 48, 100 per cent of participants on DTG/3TC achieved viral suppression, demonstrating strong treatment effectiveness among older adults.
The study also highlighted the high burden of co-morbidities among older people living with HIV, including kidney disease, diabetes, hypertension, and osteoporosis. Researchers emphasized that these conditions must be carefully considered when selecting antiretroviral therapy for aging populations.
One-size-fits-all approach questioned
“Dolutegravir-based treatment has transformed HIV care globally,” said Dr. Loice Ombajo, Chief Investigator of the Ndovu study and Co-Director at CEMA.
“But our findings show that we still lack critical data on interventions for key populations in Africa, including children, people with persistent viraemia, and older adults above 60 years. Without these data, treatment guidelines risk being either insufficient or overly aggressive.”
She added that the findings challenge assumptions that uniform global treatment approaches are always appropriate in African contexts.
“From the Ndovu results, it is clear that a one-size-fits-all approach may not be optimal. We need better tools and data to distinguish who truly needs a treatment switch and who can safely continue DTG with adherence support,” she said.
The Ndovu project is a multi-country study underway in Kenya, Tanzania, Lesotho, and Mozambique, enrolling individuals with high viral loads while on DTG to better understand adherence challenges and potential drug resistance.
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As African countries continue expanding DTG-based treatment programs, researchers emphasized the need for robust local evidence to maximize viral suppression while preserving future treatment options.
“Data saves lives. To end HIV as a public health threat in Africa, we must generate evidence that reflects the realities of the populations most affected,” Dr. Ombajo said.
The Ndovu studies were funded by the Gates Foundation, while the Sungura study received funding from ViiV Healthcare. All studies were conducted in partnership with Kenya’s Ministry of Health through the National AIDS and STI Control Programme (NASCOP) and were sponsored by the University of Nairobi.
The Centre for Epidemiological Modelling and Analysis is a multidisciplinary research centre focused on improving health outcomes through data-driven public health research, bringing together infectious disease specialists, epidemiologists, computer scientists, and data analysts.