{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:15:08Z","timestamp":1760487308574,"version":"build-2065373602"},"reference-count":69,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"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":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Syphilis remains a public health concern in Peru. Pre\u2010exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi\u2010country PrEP demonstration project; however, this analysis focuses on Peru.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between April 2018 and June 2021, 2292 HIV\u2010negative MSM\/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged \u226518 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis\/symptoms) and\/or transactional sex. Quarterly follow\u2010up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive\u2010treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed \/ #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre\u2010COVID\u201019 lockdown (up to 16 March 2020) and during COVID\u201019\u2010lockdown (17 March 2020\u2212June 2021).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 2039 cisgender\u2010MSM and 253 TW, with a median follow\u2010up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases\/100 person\u2010years (p.y.) (95% CI: 7.9\u221210.4), 14.7\/100 p.y. (95% CI: 10.5\u221220.1) among TW and 8.3\/100 p.y (95% CI: 7.1\u221210.0) among cisgender\u2010MSM. During the COVID\u201019 pre\u2010lockdown period, syphilis incidence was 10.0\/100 p.y. (95% CI: 8.3\u221212.1) and 8.1\/100 p.y. (95% CI: 6.6\u221210.0) during\u2010lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP\u2010adherent participants (MPR\u22650.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08\u22121.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11\u22122.11]) and TW (aIRR: 1.64 [95% CI: 1.08\u22122.51]). Syphilis incidence pre\u2010lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43\u22123.86]); during\u2010lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67\u22124.36]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Syphilis incidence is high among PrEP\u2010adherent MSM\/TW, those reporting receptive\u2010CAS and among TW. Health systems implementing PrEP should strengthen existing STI prevention strategies and incorporate new ones, like Doxy\u2010PEP for PrEP\u2010adherent MSM, TW and individuals engaging in receptive\u2010CAS. MPR may be a tool to identify PrEP users at risk for syphilis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.70002","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T03:19:17Z","timestamp":1756351157000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High syphilis incidence among PrEP\u2010adherent men who have sex with men and transgender women in Peru"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8188-9598","authenticated-orcid":false,"given":"Silver K.","family":"Vargas","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n Interdisciplinaria en Sexualidad SIDA y Sociedad Universidad Peruana Cayetano Heredia  Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelika A.","family":"Konda","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Interdisciplinaria en Sexualidad 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