Nearly 400,000 people living with HIV in Kenya did not receive a viral load test in the final quarter of 2025, new data shows, a gap that could allow undetected treatment failures to silently accumulate across the country’s antiretroviral programme.
Viral load testing measures the amount of HIV in a patient’s blood. A suppressed result, generally below 1,000 copies per millilitre, indicates that treatment is working and the risk of transmission is low.
An analysis of data from a report by the United States President’s Emergency Plan for Aids Relief (Pepfar) shows that of the 1.3 million people currently receiving antiretroviral therapy in Kenya, 928,229 (70.1 percent) had a documented viral load test during this period.
The remaining 395,923 patients had no recorded result, leaving clinicians without confirmation of viral suppression or early signals of treatment resistance. Among those tested, Kenya recorded a viral suppression rate of 97.4 percent, exceeding the UNAids global benchmark of 95 percent and national targets.
However, when measured across all 1.3 million patients currently on therapy, including the 395,923 patients with no recorded test results, the effective suppression rate falls to 68.3 percent, meaning that nearly one in three individuals lacks verified treatment outcomes.
Kenya is one of the countries that set a population viral load suppression target of 86 percent by September last year under the UNAids 95-95-95 framework. Current performance, measured across the full treatment population rather than among tested patients alone, indicates that the country remains below this threshold.
This shortfall is the direct result of the funding disruption that halted Pepfar’s operations last year. In January 2025, US President Donald Trump signed Executive Orders initiating a comprehensive review of overseas aid, resulting in an abrupt stop-work order that suspended Pepfar activities across its partner countries.
This was followed by a 90-day pause, after which core HIV treatment and prevention services were partially resumed.
In Kenya, viral load and early infant diagnosis products are mainly procured through Pepfar support. This means that the gap in testing coverage is also directly tied to the freeze on foreign assistance.
The Centre for Global Development estimated that approximately 65 percent of USAid- Pepfar awards were terminated, affecting support for 2.3 million people on treatment, nearly one-third of viral load testing services, and over one-third of new PrEP users.
An assessment by the Kenyan government, involving the Council of Governors, the National Syndemic Diseases Control Council (NSDCC), the National AIDS and STI Control Programme (Nascop), and the Kenya Medical Supplies Authority (Kemsa), found that reagents critical for measuring viral load suppression were among the supplies most adversely affected by the stop-work order.
The NSDCC and the Nascop subsequently warned in a joint document that, without urgent intervention, Kenya could see new HIV infections triple, rising from 16,752 to 58,495 per year.
Speaking as the freeze took effect, Director General of Health Patrick Amoth acknowledged the extent of Kenya’s exposure.
‘Kenya has made remarkable progress in the fight against HIV/Aids, with 98 percent of people living with HIV aware of their status and on treatment, and 94 percent achieving viral suppression. The ministry is actively engaging with other development partners and investing in local pharmaceutical manufacturing to prevent treatment disruptions,’ he said.
Despite this pressure, Kenya’s programme maintained continuity in treatment coverage, closing the quarter with 1.32 million patients on antiretroviral therapy-a 1.9 percent increase on the 1.29 million recorded two years prior.
This stability was attributed to ring-fenced funding for antiretroviral commodities and supply chain interventions that ensured the continued availability of drugs throughout the freeze.
The data shows that 1.29 million HIV tests were conducted during the quarter, yielding 16,057 new positive diagnoses at a positivity rate of 1.25 percent. Kenya has now diagnosed around 94 per cent of people living with HIV, approaching the first of the three UNAids targets.
However, with the remaining undiagnosed population concentrated in specific geographies and high-risk groups, the country is facing diminishing returns from broad-based testing strategies.
Public health specialists, therefore, recommended shifting towards index testing and expanding self-testing, particularly in high-burden counties such as Homa Bay, Siaya and Kisumu, as this is the most efficient way of closing the remaining diagnostic gap.
Globally, Pepfar-supported HIV testing declined by 21 percent in the same quarter compared to a year earlier, falling from 21.9 million to 17.2 million tests, while diagnoses dropped from 385,000 to 307,000.
In terms of prevention, new PrEP enrolments declined from 36,991 in the same quarter two years before to 35,258 the following year. Pepfar did not publish PrEP initiation data for the most recent quarter, creating a visibility gap at a time when prevention trends are of particular importance.
Across Pepfar-supported programmes globally, PrEP uptake fell by 37 percent in the first half of the reporting year, with adolescent girls and young women being disproportionately affected by any further contraction in prevention services.
Against these pressures, paediatric indicators offer one of the few genuinely positive signals. The number of children under 15 on treatment fell from 52,000 to 47,000 over the two-year comparison period-a decrease of 9.6 percent reflecting gains in the prevention of mother-to-child transmission rather than treatment attrition.