Kenya has made significant strides in the fight against HIV by transitioning to Dolutegravir (DTG)-based antiretroviral therapy (ART), in line with the World Health Organization’s (WHO) guidelines. This shift is expected to enhance treatment outcomes for people living with HIV by providing a more effective, safer, and better-tolerated option compared to older treatments.
The Ministry of Health in Kenya has prioritized the transition to DTG, especially for adults and adolescents currently on second-line Atazanavir/r therapy. This move is part of phase 3 optimization efforts aimed at improving the country’s HIV treatment protocols. DTG has proven to be highly effective in suppressing the viral load, with fewer side effects and a reduced risk of resistance compared to older medications like Efavirenz (EFV) and Nevirapine (NVP).
The introduction of DTG in Kenya’s treatment guidelines began in 2017, after clinical trials demonstrated its superiority over other first-line therapies. Initially, 27,000 individuals who could not tolerate the side effects of efavirenz were switched to DTG. By 2019, WHO endorsed DTG as the preferred first- and second-line HIV treatment for all populations, including pregnant women and those of childbearing potential, after further evidence confirmed its safety and efficacy.
Despite concerns raised in 2018 following a Botswana study that linked DTG use to neural tube defects, updated data from large clinical trials in Africa have shown that the risks are much lower than initially feared. This has led to a global consensus on the safety of DTG, making it a more favorable option for people living with HIV, including pregnant women.
DTG offers numerous advantages over older HIV treatments. Its high efficacy in viral suppression and its strong genetic barrier to resistance make it a valuable tool in the long-term management of HIV. Unlike EFV and NVP, which have lower resistance barriers and are associated with a higher risk of side effects, DTG is generally better tolerated. Side effects from EFV and NVP can include neuropsychiatric symptoms like vivid dreams, anxiety, and depression, as well as liver toxicity. DTG, on the other hand, has fewer side effects, with concerns about neural tube defects in pregnancy largely mitigated by recent studies.
Additionally, DTG is available in once-daily formulations, making it more convenient for patients compared to the more complex dosing regimens of older treatments. This ease of use, combined with its lower risk of resistance and fewer side effects, has made DTG a popular choice for HIV treatment worldwide. Its increasing affordability, particularly in low- and middle-income countries, has also contributed to its widespread adoption.
Kenya has seen remarkable progress in its HIV response, with 98% of adults living with HIV receiving treatment by the end of 2023, and 97% of them achieving viral suppression. New HIV infections have decreased by 83% over the past decade, and AIDS-related deaths have declined by 64%. This success is a testament to the effectiveness of Kenya’s expanded access to ART and improved healthcare services.
The country is also working towards achieving the UNAIDS 95-95-95 targets, aiming to ensure that 95% of people living with HIV are diagnosed, 95% of those diagnosed are receiving ART, and 95% of those on ART have undetectable viral loads. These efforts are aligned with the global goal to end the AIDS epidemic by 2030. However, continued focus on reaching underserved populations and reducing stigma will be essential in sustaining this progress and achieving an HIV-free generation.
