Kenya has taken a significant step in its fight against HIV by transitioning to the dolutegravir (DTG)-based antiretroviral therapy (ART) regimen for people living with the virus. This move aligns with recommendations from the World Health Organization (WHO), marking an important milestone in the country’s HIV treatment landscape. The transition, which follows the increasing adoption of DTG globally, comes in the wake of some concerns about shortages of the commonly used Atazanavir-based regimens.
The Ministry of Health has emphasized that the shift to the DTG-based regimen is not only in line with global best practices but also aims to improve treatment outcomes for individuals living with HIV. Studies have shown that DTG is more effective, has fewer side effects, and poses a lower risk of drug resistance compared to older ART options. This new treatment approach is part of Kenya’s ongoing efforts to optimize HIV care, and it focuses on those who are eligible for a regimen change, specifically adults and adolescents currently on second-line Atazanavir/r therapy.
This shift is particularly important as it helps meet the growing need for more effective HIV treatments. The country has been progressively integrating DTG into its HIV treatment guidelines, with its initial use dating back to 2017 when 27,000 people living with HIV were introduced to the drug. These were individuals who could not tolerate the side effects of the previous first-line drug, efavirenz. The broader adoption of DTG became a reality in 2019 when WHO approved it as the preferred first- and second-line treatment for all populations, including pregnant women and those of childbearing potential.
The move towards DTG was prompted by new evidence showing that the drug is not only safe but also highly effective, even for women of reproductive age. Earlier concerns about potential risks, particularly for neural tube defects in babies conceived while on DTG, had sparked some hesitation. However, subsequent research has shown that these risks were much lower than initially feared, confirming that DTG is safer and more beneficial in the long term.
DTG offers several advantages over older HIV drugs like efavirenz (EFV) and nevirapine (NVP), which had been widely used in Kenya’s HIV treatment protocols. One of the key benefits of DTG is its efficacy in suppressing the viral load, with clinical trials showing superior outcomes compared to the older regimens. In addition, the drug has fewer side effects, such as dizziness or liver toxicity, which were common complaints among patients on EFV and NVP.
Furthermore, DTG has a higher genetic barrier to resistance, making it a preferred option for patients with drug-resistant HIV strains. This is crucial because resistance to drugs like EFV and NVP is rising, particularly in sub-Saharan Africa, where pre-treatment resistance rates have exceeded 10% in many countries.
Despite some concerns raised about potential stockouts of ARVs, particularly Atazanavir, the Kenya Medical Supplies Agency (KEMSA) has reassured the public that there are no current shortages of antiretroviral medications. KEMSA CEO Waqo Erjesa clarified that the transition to DTG-based regimens may have led to confusion, but assured that the agency has sufficient stocks to meet the demand for HIV treatment.
In his remarks, Erjesa also explained that the transition from Atazanavir to DTG was part of Kenya’s commitment to adopting more effective treatments, which could have led to some misunderstandings among patients. He emphasized that the government, along with international partners like the Global Fund and the United States, has been working diligently to ensure a stable supply of ARVs.
Kenya’s HIV response has made tremendous strides in recent years. As of 2023, 98% of adults living with HIV in Kenya were receiving treatment, and 97% of these individuals had achieved viral suppression. This success is a result of the government’s strong commitment to expanding access to ART and improving healthcare services across the country.
Additionally, new HIV infections have dropped by 83% over the past decade, and AIDS-related deaths have decreased by 64%. These accomplishments are in line with global targets set by UNAIDS, which aims to eliminate the AIDS epidemic by 2030. Kenya’s focus on prevention, early diagnosis, and expanded access to treatment has been a cornerstone of these achievements.
While significant progress has been made, challenges remain. Reaching underserved populations, addressing stigma, and ensuring the continued availability of essential medications will be crucial for sustaining momentum. Moreover, as Kenya continues to transition to DTG, ensuring proper education and awareness for patients will help mitigate any confusion around the new treatment protocols.
In the long term, Kenya’s efforts to combat HIV and reduce new infections are key to achieving an HIV-free generation. The country’s recent strides in treatment, prevention, and access to care are setting an example for other nations in the region and across the globe. Through continued efforts, Kenya remains on track to meet the ambitious targets of ending the AIDS epidemic by 2030.
