Kenya study: 41 percent of HIV-positive children not suppressed
A major Kenya-led HIV study has found that 41% of HIV-positive children and adolescents on dolutegravir (DTG) treatment were not virally suppressed after three months, despite enhanced adherence counselling--raising urgent questions about how HIV treatment is managed across Africa.
The findings were presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) and led by researchers from the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi.
With dolutegravir-based regimens now the backbone of first-line HIV treatment across Africa, scientists say the data exposes critical gaps in how children, adults with persistent viraemia, and older patients are managed.
41 percent of children on DTG fail viral suppression
The Ndovu study examined children and adolescents in Kenya who had high HIV viral loads while on dolutegravir, the drug widely rolled out in sub-Saharan Africa since 2019.
Despite enhanced adherence support:
- 41 percent failed to suppress the virus after three months
- Many remained with persistent viraemia--meaning the virus was still detectable in their blood
Researchers say this suggests current interventions may not be enough for paediatric patients experiencing DTG treatment failure.
“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 and adolescents.”
Should adults automatically switch HIV drugs?
A second Ndovu analysis focused on adults with two consecutive high viral load results while on dolutegravir.
Under current World Health Organisation (WHO) guidelines, patients in resource-limited settings are often switched to a protease inhibitor (PI) regimen after two high viral loads if drug resistance testing is unavailable.
However, the study found that many adults were able to achieve viral suppression without changing treatment.
Researchers warn that automatic switching could lead to unnecessary drug changes, limit future treatment options, and increase health care costs in African settings.
“We need better tools and data to distinguish who truly needs a switch and who can safely continue DTG with adherence support,” Dr Ombajo said.
100% suppression in adults over 60
In contrast, the Sungura study--a 96-week trial conducted at two Kenyan sites--showed encouraging results among older adults living with HIV.
Participants aged 60 and above were switched from B/F/TAF therapy to DTG/3TC dual therapy (dolutegravir/lamivudine).
The outcome:
100% of participants were virally suppressed at week 48
However, researchers noted high levels of co-morbidities including kidney disease, diabetes, hypertension, and osteoporosis in this aging population--highlighting the need to carefully select antiretroviral regimens that minimise long-term toxicity.
As Africa’s population of older adults living with HIV continues to grow, treatment decisions must increasingly account for chronic health conditions alongside viral suppression.
Why this matters for Africa’s HIV response
Africa carries the world’s largest HIV burden.
As countries scale up dolutegravir-based treatment under standardised global guidelines, these new findings suggest that a one-size-fits-all approach may not work.
The stakes are high:
- Poor viral suppression increases transmission risk
- Premature switching may exhaust future treatment options
- Delayed switching may allow resistance to develop
Researchers say African policymakers require stronger, context-specific data to ensure treatment strategies maximise viral suppression while preserving future drug options.
“Data saves lives,” Dr Ombajo said.
“To end HIV as a public health threat in Africa, we must generate evidence that reflects the realities of the populations most affected.”
With millions of Africans on dolutegravir-based HIV treatment, scientists warn that without better local evidence, treatment guidelines risk missing the mark--especially for children.
In the fight to end HIV in Africa, the right data may prove just as critical as the drugs themselves.
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