A major multi-country study, the Ndovu Project, is investigating HIV treatment failure and drug resistance linked to dolutegravir (DTG), the cornerstone of modern antiretroviral therapy in Africa. The research aims to generate evidence to improve clinical management for patients whose treatment is failing, a situation that threatens lives across the continent.
Dolutegravir-based regimens are the global first-line treatment for HIV. When taken consistently, these drugs suppress the virus to undetectable levels. However, treatment failure, often driven by poor medication adherence, can cause the viral load to rebound. In some cases, the virus develops resistance to DTG. This is particularly concerning because DTG is a critical drug with few alternatives; failure on this regimen can lead to severe illness and death.
The Ndovu Study is enrolling people living with HIV in Kenya, Tanzania, Lesotho, and Mozambique who have a high viral load while on DTG treatment. The project closely monitors these patients, provides adherence support, conducts drug resistance testing, and assesses for advanced HIV disease. By analysing this data, researchers seek to understand the patterns of failure and resistance and define optimal clinical pathways.
The study is led by the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi, in collaboration with national health ministries and universities in the participating countries, and is funded by the Bill & Melinda Gates Foundation. Investigators stress that early findings highlight the urgent need for better tools to detect resistance and strengthen adherence support systems.
“The data will inform national and international guidelines on managing patients who fail DTG-based treatment,” said Dr. Loice Ombajo, Chief Investigator. Principal Investigators in each country noted that the study’s real-world evidence is already shaping discussions on laboratory strengthening, patient retention, and policy updates.
With the World Health Organization reporting 630,000 HIV-related deaths globally in 2024, the need to revolutionise HIV care is critical. The Ndovu team plans to present comprehensive findings to guide ministries of health. A key investigators’ meeting is scheduled for early 2026 to align on the next phase, with the ultimate goal of ensuring no patient is left behind in the HIV response.
