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Accordingly, the Global Evaluation of Microbicide Sensitivity (GEMS) project was established to monitor HIVDR in PrEP rollout programmes in Southern and Eastern Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>GEMS monitored resistance in &gt;100,000 estimated persons who accessed PrEP through national programmes or implementation projects in Southern\/Eastern Africa. Participants self\u2010reported demographics and PrEP adherence. HIV\u20101 RNA and tenofovir\u2010diphosphate levels were measured in blood samples collected at the time of study enrolment from consenting participants diagnosed with HIV who had received PrEP. HIVDR mutations were detected by population genotyping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 283 reported seroconversions on PrEP from December 2017 through September 2023, 255 (90%) individuals enrolled in GEMS, of which 81 (32%) were from Kenya, 77 (30%) from South Africa, 69 (27%) from Zimbabwe and 28 (11%) from Eswatini. Half (130; 51%) were 15\u201324 years of age at seroconversion, and three\u2010quarters (193; 76%) were female. Thirty\u2010four seroconversions occurred within 30 days of PrEP initiation. Tenofovir\u2010diphosphate levels were consistent with moderate to high levels (\u2265350 femtomoles per punch) in 53% (120 of 226) individuals with drug\u2010level data. Of 154 samples successfully genotyped, 34 (22%; 95% CI [16%, 30%]) had PrEP\u2010associated mutations; these included 27 samples with M184I\/V, one sample with K65KR, and six samples with both K65R and M184I\/V.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The frequency of HIVDR mutations associated with tenofovir or emtricitabine among individuals diagnosed with HIV who had received PrEP (22%) exceeded background levels of transmitted nucleoside\n                      <jats:italic>reverse transcriptase<\/jats:italic>\n                      inhibitor resistance in Southern and Eastern Africa (\u22645%) but people with PrEP\u2010associated mutations are likely to achieve virologic suppression with current first\u2010line antiretroviral therapy (ART). Improved screening for acute infection before initiating PrEP, surveillance of HIVDR with the introduction of new PrEP programmes and the monitoring of longer\u2010term ART outcomes in individuals who acquire HIV\u20101 on PrEP will be essential to preserve antiretroviral options for both treatment and prevention.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70011","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T05:35:40Z","timestamp":1755754540000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A cross\u2010sectional study evaluating the frequency of HIV drug resistance mutations among individuals diagnosed with HIV\u20101 in tenofovir disoproxil fumarate\u2010based pre\u2010exposure prophylaxis rollout programmes in Kenya, Zimbabwe, Eswatini and South Africa"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4016-0629","authenticated-orcid":false,"given":"Urvi M.","family":"Parikh","sequence":"first","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren D.","family":"Kudrick","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Levy","sequence":"additional","affiliation":[{"name":"FHI 360  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everline","family":"Bosek","sequence":"additional","affiliation":[{"name":"University of Washington\u2010Kenya  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavna H.","family":"Chohan","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute 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