By Lazarus Momanyi, National AIDS and STI Control Programme (NASCOP), Ministry of Health, Kenya
In 2021, Kenya decided to update national guidance, shifting the first VL from month six to month three to harmonize monitoring across all populations. The month three VL result is available for review during the clinical encounter at month six. The early integration of dolutegravir (DTG) as the preferred first-line agent in Kenya in 2017 provided the pharmacological foundation for this policy change.
Key lessons learnt from Kenya’s implementation of early VL testing were that an early VL is feasible and does not translate to additional VL requirements or costs. With most clients having transitioned to the more efficacious DTG-based ART, suppression rates are favourable, allowing for early transition to less-intense DSD.
The revised Kenya Integrated Guidelines for HIV, STI and Viral Hepatitis 2026 (forthcoming) represent a strategic pivot toward a more resilient and person-centred HIV response, balancing high-quality clinical care with the realities of a shifting global funding landscape. The revised guidance also expands six-multi-month dispensing of ART and introduces an annual clinical review for clients established on ART. Kenya is further expanding access to VL testing by scaling innovative technologies, such as point-of-care and multiplexing platforms.
DSD policy dashboards on the visit schedule in the first year on HIV treatment
This dashboard combines all clinical reviews, viral load test timing and ART refill visits, as outlined in the national guidelines of 15 countries, to determine the likely visit schedule for the first 12 months on ART.
In most African countries, the first VL is taken six months after starting ART. Results are typically available at the clinical consult thereafter, delaying DSD enrolment and support for those who are unsuppressed, despite guidelines recommending earlier entry. Eswatini, Kenya and South Africa are implementing earlier viral load testing.
