{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:28:46Z","timestamp":1786343326359,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tenofovir\u2010based oral pre\u2010exposure prophylaxis (PrEP) is pivotal for HIV prevention in Latin America. Monitoring PrEP adherence is crucial for maximizing its impact and identifying individuals who may benefit from additional support. We evaluated the performance of indirect adherence measures and factors associated with PrEP non\u2010adherence in Brazil, Mexico and Peru.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ImPrEP was a prospective, multicentre, PrEP implementation study which enrolled 9509 persons from 6 February 2018 to 30 June 2021. For this analysis, we included men who have sex with men (MSM) aged 18\u201324 years and transgender women aged 18+ years with at least one dried blood spot (DBS) sample collected. Adherence was assessed objectively (tenofovir diphosphate [TFV\u2010DP] levels in DBS) and indirectly (medication possession rate [MPR] and self\u2010report). We estimated area under the curve (AUC) to evaluate the performance of each indirect adherence measure, and the optimal cut\u2010off points for discriminating protective TFV\u2010DP levels based on the Youden index. We used generalized estimating equations to identify factors associated with PrEP non\u2010adherence (TFV\u2010DP&lt;900 fmol\/punch).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 2096 participants (1692 young MSM and 404 transgender women) with 4257 DBS samples. Overall, 62.3% DBS samples showed protective TFV\u2010DP levels, which declined over time (68.8% at week 4 to 33.8% at week 124). Both MPR and self\u2010report demonstrated moderate concordance (AUC: 0.74) with no difference between them (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.79). Optimal cut\u2010offs were 97.6% for MPR and 93.3% for self\u2010report; self\u2010report showed higher sensitivity (84.6%), while MPR had higher specificity (62.9%). Among young adults, PrEP non\u2010adherence was higher among transgender women, participants with lower education and from Peru. Among transgender women, PrEP non\u2010adherence was higher among those with younger age, lower education, and from Peru and Mexico. Self\u2010reported sexual behaviours conveying elevated HIV exposure were associated with lower PrEP non\u2010adherence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MPR and self\u2010report are pragmatic and clinically useful adherence monitoring tools for PrEP programmes in Latin America. Social determinants of health, particularly education, emerged as major drivers of PrEP non\u2010adherence among transgender women and young MSM. To maximize impact, PrEP programmes must prioritize person\u2010centred interventions that address stigma within health services, remove barriers to sustained engagement, strengthen health literacy and include long\u2010acting PrEP modalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70154","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:40:34Z","timestamp":1785048034000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Using Tenofovir Diphosphate Levels to Evaluate Factors Associated With PrEP Non\u2010Adherence and Performance of Indirect Adherence Measures in Latin America: A Prospective, Single\u2010Arm, Open\u2010Label, Multicentre Implementation Study (ImPrEP)"],"prefix":"10.1002","volume":"29","author":[{"given":"Thiago S.","family":"Torres","sequence":"first","affiliation":[{"name":"Instituto Nacional de Infectologia Evandro Chagas, 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