{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:37:09Z","timestamp":1787870229627,"version":"build-2784847793"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Adherence counselling with point\u2010of\u2010care (POC) drug\u2010level feedback using a novel tenofovir assay may support pre\u2010exposure prophylaxis (PrEP) adherence; however, perceptions of urine testing and its impact on adherence are not well studied. We qualitatively examined how POC tenofovir testing was experienced by transgender women (TGW) in Uganda.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Within a cluster randomized trial of peer\u2010delivered HIV self\u2010testing, self\u2010sampling for sexually transmitted infections and PrEP among HIV\u2010negative TGW showing overall low PrEP prevention\u2010effective adherence (NCT04328025), we conducted a nested qualitative sub\u2010study of the urine POC assay among a random sample of 30 TGW (August 2021\u2212February 2022). TGW interviews explored: (1) experiences with POC urine tenofovir testing and (2) perceptions of PrEP adherence counselling with drug\u2010level feedback. We used an inductive content analytic approach for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age was 21 years (interquartile range 20\u201324), and 70% engaged in sex work. Four content categories describe how TGW experienced POC urine tenofovir testing: (1) Urine tenofovir testing was initially met with scepticism: Testing urine to detect PrEP initially induced anxiety, with some perceptions of being intrusive and unwarranted. With counselling, however, participants found POC testing acceptable and beneficial. (2) Alignment of urine test results and adherence behaviours: Drug\u2010level feedback aligned with what TGW knew about their adherence. Concurrence between pill taking and tenofovir detection in urine reinforced confidence in test accuracy. (3) Interpretation of urine tenofovir results: TGW familiar with the interpretation of oral\u2010fluid HIV self\u2010tests knew that two lines on the test device signified positivity (presence of HIV). However, two lines on the urine test strip indicated a positive result for non\u2010adherence (absence of tenofovir), causing confusion. Research nurses explained the difference in test interpretation to participants\u2019 satisfaction. (4) White coat dosing: Some TGW deliberately chose not to attend scheduled clinic appointments to avoid detecting their PrEP non\u2010adherence during urine testing. They restarted PrEP before returning to clinic, a behaviour called \u201cwhite coat dosing.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incorporating POC urine testing into routine PrEP adherence counselling was acceptable and potentially beneficial for TGW but required attention to context. Additional research is needed to identify effective strategies for optimizing adherence monitoring and counselling for this population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26255","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T08:15:00Z","timestamp":1714637700000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Urine tenofovir testing for real\u2010time PrEP adherence feedback: a qualitative study involving transgender women in Uganda"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6646-6733","authenticated-orcid":false,"given":"Andrew","family":"Mujugira","sequence":"first","affiliation":[{"name":"The Infectious Diseases Institute Limited Makerere University  Kampala Uganda"},{"name":"Department of Global Health University of Washington  Seattle Washington 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