{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T23:59:04Z","timestamp":1785110344578,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":11,"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":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pre\u2010exposure prophylaxis (PrEP) services are linked to increased sexually transmitted infection (STI) diagnoses, which may facilitate PrEP uptake. We hypothesized that point\u2010of\u2010care (POC) STI testing and treatment would improve PrEP initiation and persistence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between September 2023 and November 2024, we conducted a single\u2010centre, open\u2010label, unblinded, randomized controlled trial among adolescent girls and young women (15\u221229 years old) or male partners (any age). Participants were randomized 1:1 to standard syndromic STI management (SOC) or POC testing for <jats:italic>C. trachomatis<\/jats:italic>, <jats:italic>N. gonorrhoeae<\/jats:italic>, syphilis and <jats:italic>T. vaginalis<\/jats:italic> (women only). All participants received standard HIV prevention counselling, including the offer of oral PrEP. The primary outcome was effect of POC STI testing versus syndromic management on PrEP initiation; secondary outcomes included persistence at 1 and 4 months (PrEP prescription), verified in the secondary analysis of tenofovir diphosphate (TFV\u2010DP) in dried blood spots (DBS) in a random subset. TFV\u2010DP in DBS was analysed in a subset. Analysis was intention\u2010to\u2010treat, adjusted for age and sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled and randomized 900 participants (452 in intervention; 448 in SOC). The mean age was 20.4 years (SD = 4.2); 48% were female. In the intervention arm, 435 received POC STI testing (96%); 25% (110 of 435 tested) were diagnosed with =&gt;1 STIs; 84% were treated. In SOC, 7% of participants reported symptoms of STIs (31); 88% were treated (27). Overall, 64% of participants in SOC versus 62% in intervention\u2010initiated PrEP (RR = 0.98, 95% CI = 0.88ng women and partners1.08). In the intervention, 41% persisted on PrEP at 1 month and 25% through 4 months, compared to 46% and 19%, respectively, in SOC (aRR intervention = 1.39; 95% CI = 0.93\u22122.09; <jats:italic>p<\/jats:italic> = 0.08). In participants treated for STIs or syndromically, 77% initiated PrEP versus 60% untreated\/diagnosed (aRR = 1.14; 95% CI = 1.02\u22121.27); 19% versus 14% persisted on PrEP at 4 months (aRR STI\/syndrome treated = 1.41; 95% CI = 0.79\u22122.51). Overall, 30% of 64 DBS had any TFV\u2010DP levels present with no difference by study arm (RR = 0.74; 95% CI: 0.38\u22121.41).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>POC STI testing did not increase PrEP initiation or 1\u2010month persistence but showed a moderate association with 4\u2010month persistence. STI treatment (syndromic or confirmed) was linked to higher PrEP uptake and persistence. Integrating STI management may improve PrEP persistence among youth.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26488","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T05:50:12Z","timestamp":1747115412000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of point\u2010of\u2010care diagnostics for sexually transmitted infection on oral PrEP initiation and persistence among young people in South Africa: a randomized controlled study"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6290-9293","authenticated-orcid":false,"given":"Dvora","family":"Joseph Davey","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Geffen School of Medicine University of California  Los Angeles California USA"},{"name":"Desmond Tutu HIV Centre Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town 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Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Leonard","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keitumetse","family":"Lebelo","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ande","family":"Kolisa","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Little","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0755-4386","authenticated-orcid":false,"given":"Linda\u2010Gail","family":"Bekker","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre Institute of Infectious Diseases and Molecular Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Prevention and control of sexually transmitted infections (STIs) in the era of oral pre\u2010exposure prophylaxis (PrEP) for HIV","author":"World Health 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