A major African-led research initiative is reshaping how the world detects and manages HIV treatment failure, as scientists warn that poor adherence and emerging drug resistance are quietly undermining progress in the global response. The multi-country Ndovu Study is generating critical real-world evidence expected to influence treatment guidelines across Africa and beyond, at a time when millions rely on modern antiretroviral therapy (ART) to survive and remain healthy.

Researchers in Kenya, Tanzania, Lesotho and Mozambique are collaborating on a landmark study to answer one of the most pressing clinical questions facing HIV programmes: what should be done when first-line therapy stops working, particularly when resistance develops to dolutegravir, the backbone of current treatment worldwide.

For more than a decade, ART has transformed HIV from a fatal infection into a manageable chronic condition. With consistent treatment, people living with HIV can suppress the virus, restore immune function, live long lives and prevent onward transmission. The rollout of dolutegravir-based regimens marked a major advance because the drug is potent, generally well tolerated and more robust against resistance than earlier medicines.