Africa: New African research shapes the future of HIV treatment globally
- Non-adherence to HIV treatment costs lives
- Ndufu’s study advances HIV treatment by redefining how treatment failure and drug resistance are detected, managed and prevented across Africa and beyond.
NAIROBI, Kenya (February 12, 2026) – A new study is generating important evidence to guide optimal management of HIV patients who fail treatment and develop resistance to dolutegravir, providing hope for millions of HIV-positive individuals across Africa and around the world.
HIV is treated with antiretroviral medications that suppress the virus in the body, allowing people 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 continuously, 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 a high viral load. In some cases, the virus can also develop resistance to treatment, meaning the medications no longer work effectively. Failure while taking dolutegravir is concerning, as treatment options are limited, putting people at risk of death.
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The Ndufu Project is a large multi-country study being implemented in Kenya, Tanzania, Lesotho and Mozambique. The project is enrolling HIV-infected individuals with a high viral load receiving treatment with dolutegravir, suggesting possible adherence difficulties or drug resistance.
Failure to adhere to HIV treatment is a major contributor to drug resistance, treatment failure, and the risk of developing advanced disease (AIDS). With many countries using dolutegravir (DTG)-based regimens as first-line HIV treatment, emerging data show that poor treatment adherence leads to virologic failure, often characterized by dangerously low CD4 cell counts and life-threatening opportunistic infections such as tuberculosis, streptococcal meningitis, and other severe infections.
The Ndufu Study is changing how treatment failure is understood and managed by closely following patients, supporting them in treatment adherence, creating an understanding of drug resistance through drug resistance testing, supporting the identification and management of advanced HIV disease and providing important data to help develop national and international guidelines on the management of HIV treatment failure.
Despite significant progress in HIV treatment, the global response remains at a critical crossroads. The World Health Organization estimates that in 2024, 40.8 million people were infected with HIV, 1.3 million people acquired HIV, and 630,000 people died from HIV-related diseases. This calls for an urgent need to revolutionize the quality of HIV care, support adherence and timely clinical decision-making.
From 26 to 28 January 2026, CEMA hosted principal investigators and partners at a three-day Ndufu Researchers’ Meeting in Naivasha, bringing together researchers from Kenya, Tanzania, Mozambique and Lesotho, along with representatives from ministries of health and implementing partners. The meeting reviewed the progress achieved over the past year and the corresponding priorities for the next phase of the study.
Nduvo teams work closely with ministries of health and national HIV programs in their countries to ensure that emerging evidence directly informs policy and clinical practice. While early results are promising, there is still much to be accomplished through continued collaboration, learning, and rapid translation of evidence into action.
The Ndufu study is sponsored by the Center for Epidemiological Modeling and Analysis (CEMA) at the University of Nairobi, in collaboration with the Kenyan Ministry of Health, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, SolidarMed in Lesotho, and the National Institute of Saudi Arabia (INS) in Mozambique, and funded by the Bill & Melinda Gates Foundation.
Through data, Ndufu addresses treatment failure, resistance, and adherence head-on, reshaping the future of HIV treatment – strengthening health systems, ensuring that no patient is left behind, and ultimately, saving lives.
Dr. Luis Umbajo“It is deeply concerning that some people are experiencing treatment failure due to non-adherence to treatment and the potential emergence of resistance to dolutegravir, putting their lives at risk,” said Ndufu, an infectious disease specialist and co-director of the Center for Epidemiological Modeling and Analysis (CEMA) at the University of Nairobi. “We urgently need evidence to guide how to manage patients when they fail treatment and when drug resistance develops. Data from this study will help inform global guidelines on how to care for people with HIV who do not respond to available treatment options.” “Right now.”
Dr. Patricia Munser“As we look forward to commencing the Ndufu clinical trial, we are confident in our ability to recruit and retain participants while ensuring high-quality data consistent with study protocols, national and international ethical and regulatory standards, and compliance with the goal of generating important evidence,” said the study’s lead researcher in Tanzania, Associate Professor and Head of the Infectious Diseases Unit in the Department of Internal Medicine at Muhimbili University of Health and Allied Sciences (MUHAS). “To inform national and regional HIV treatment policies on how best to manage patients who fail dolutegravir-based therapy.”
“We are really happy and proud to be associated with the Ndofu team, being an African-led project bringing together researchers from other African countries. We believe this is an excellent opportunity for further collaboration within the continent and globally in addressing public health challenges.”
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Dr. Irene Ayakaca“Being involved in the Ndufu study in Lesotho is a great privilege,” said the study’s lead researcher in Lesotho and Technical Director at SolidarMed, Lesotho. “The study already demonstrates that sustaining gains in HIV treatment – especially in Africa – requires early detection of drug resistance and routine surveillance to prevent widespread treatment failure.” Key lessons 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 ideas shape discussions at the highest levels and will directly inform national guidelines. To treat HIV.
Dr. Nalia Ismail “The Ndovo study provides the latest real-world data led by African researchers. Although significant efforts have been made in Mozambique to strengthen HIV treatment care management, gaps remain, especially regarding patient retention and adherence and increased HIV drug resistance,” said the lead researcher in Mozambique.
“We believe that the results of this study will provide important insights and guidance to the National HIV Treatment Program on how to better manage these patients, especially in the scenario where patients continually fail DTG regimens. Our goal in collaboration with the Ministry of Health is to provide high-quality, real-time data that will improve patient outcomes.”
