New HIV studies presented this week at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) highlight critical evidence gaps that must be addressed to improve HIV treatment strategies across Africa.
Researchers from the Centre for Epidemiological Modelling and Analysis (CEMA), University of Nairobi, presented Ndovu and Sungura studies examining treatment outcomes among children and adults with persistent viraemia (presence of HIV virus in the blood) while on dolutegravir-based regimens, and older adults living with HIV.
Together, the findings highlight the need for more context-specific data to guide treatment and policy decisions for HIV patients as follows:
- 41% of children and adolescents failed to suppress the virus after three months despite enhanced adherence counselling interventions, underscoring the need for further research on effective interventions for children and adolescents experiencing dolutegravir (DTG) treatment failure.
- Many people who have two high viral load test results while on DTG are still able to suppress the virus without changing treatment, highlighting the need for stronger data to determine whether adults with viraemia while on a DTG should switch to a protease inhibitor (PI) after two consecutive high HIV viral loads without a drug resistance test, according to WHO guidance.
- 100% of the participants on DTG/3TC (dolutegravir/ lamivudine) dual therapy were virally suppressed at week 48 in an aging population living with HIV, stressing the need for additional considerations when selecting antiretroviral therapy for adults aged 60 years and older, given the high burden of co-morbidities (other new or existing long-term health conditions) in this population.
“Dolutegravir-based treatment has transformed HIV care globally,” says Dr Loice Ombajo, chief investigator for 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.”
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 on treatment with dolutegravir, indicating possible adherence difficulties or drug resistance.
One Ndovu abstract focused on children and adolescents persistent with viraemia despite adherence support. Paediatric dolutegravir (DTG) formulations were introduced across many sub-Saharan African countries in 2019.
In a large Kenyan cohort of children and adolescents with high viral loads while on DTG, 41% failed to suppress the virus after three months, despite enhanced adherence counselling interventions, as mentioned above.
These findings expose a significant research gap to identify and implement effective strategies to better support children and adolescents with DTG treatment failure.
The second Ndovu abstract looked at adults with viraemia while on a DTG-based antiretroviral regimen. It showed that many people who have two high viral load test results while on DTG are still able to suppress the virus without changing treatment.
The World Health Organisation (WHO) and multiple countries in resource-limited settings recommend a switch to a protease inhibitor (or PI) after two consecutive high HIV viral loads while on a DTG-based regimen without a drug resistance test.
This study suggests that the current WHO guidance could lead to many unnecessary drug switches, as there is limited data to support this strategy.
The Sungura Study, a 96-week, open-label study conducted at two Kenyan sites, evaluated the efficacy and safety of switching older adults from B/F/TAF (short for Bictegravir/Emtricitabine/Tenofovir Alafenamide for the Elderly) to DTG/3TC (dolutegravir/ lamivudine) dual therapy among older adults over 60 years of age.
As the population of older adults living with HIV grows in Africa, treatment strategies must account for comorbidities and long-term drug toxicity.
From the study, 100% of the participants on DTG/3TC dual therapy were virally suppressed at week 48 in an aging population living with HIV.
Co-morbidities such as kidney disease, diabetes, hypertension and osteoporosis (weak bones) were common, highlighting additional considerations for selecting antiretroviral agents for older populations.
“From the Ndovu results, it is clear that a one-size-fits-all approach may not be optimal,” says Dr Ombajo. “We need better tools and data to distinguish who truly needs a switch and who can safely continue DTG with adherence support.”
The three studies highlight a central message: while global HIV treatment guidelines are increasingly standardised, African populations face distinct clinical realities that require locally generated evidence.
As African countries scale up DTG-based regimens, policymakers require robust, context-specific data to ensure treatment decisions maximise 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,” concludes Dr Ombajo
The Ndovu studies were funded by the Gates Foundation, while the Sungura study was funded by ViiV Healthcare. All studies were conducted in partnership with the Ministry of Health through the National AIDS/STI Control Program (NASCOP) in Kenya and sponsored by the University of Nairobi.