{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:10:56Z","timestamp":1790327456705,"version":"4.1.0"},"reference-count":55,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Daily oral pre\u2010exposure prophylaxis (PrEP) use remains low among adolescent girls and young women (AGYW). We evaluated whether a peer support intervention improved daily oral PrEP uptake and adherence among AGYW at high risk of HIV acquisition in Kampala, Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an open\u2010label randomized controlled trial (January 2023\u2212June 2024) among 14\u2010 to 24\u2010year\u2010olds engaged in sex work. Eligible participants were randomized 1:1 to receive either health worker counselling only (control) or supplemented with peer support (intervention). Peer leaders delivered co\u2010created peer education sessions starting 1 month after enrolment. Participants were followed for 12 months. Co\u2010primary outcomes were PrEP uptake (yes\/no) and adherence, evaluated using two separate measures; optimal if: \u226585% pill\u2010counts (primary measure); positive point\u2010of\u2010care urine tenofovir test. Both arms received adherence counselling based on urine results. Secondary outcomes: PrEP persistence (time to discontinuation) and cost\u2010effectiveness (cost per disability adjusted life year\/DALY averted). Analysis used logistic regression (uptake); generalized estimating equations (adherence), Cox regression (persistence) and incremental cost\u2010effectiveness ratio (ICER) below US$537 per DALY averted was considered cost\u2010effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 394 participants (197 per arm) with a mean age of 19.4 (SD \u00b12.3) years. The intervention did not impact PrEP uptake (OR 1.15; 95% CI 0.77\u22121.71) but improved adherence, pill count (OR 2.20; 95% CI 1.23\u22123.95) and urine assay (OR 2.18; 95% CI 1.22\u22123.91). Optimal adherence was low but significantly higher in the intervention by both measures: pill count (intervention = 54.8%, control = 39.6%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008), urine assay (intervention = 54.8%, control = 40.8%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). Median duration before PrEP discontinuation was 38 days (IQR 0\u2013319 days); intervention (56 days), control (29 days). The intervention had no effect on persistence (HR 0.86; 95% CI 0.64\u22121.14). It was cost\u2010effective with the urine tenofovir assay (ICER = $459) but not with pill counts (ICER = $581).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This peer\u2010led intervention improved PrEP adherence among AGYW in Kampala and is recommended in high\u2010incidence settings. Urine tenofovir testing can be used to assess adherence if affordable. Enhanced peer support strategies are needed until long\u2010acting PrEP becomes accessible and acceptable. Future research should optimize timing, intensity and delivery models of peer support interventions and integrate them with long\u2010acting PrEP to improve sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70210","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:33:19Z","timestamp":1789975999000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of a Peer Support Intervention for Oral Pre\u2010Exposure Prophylaxis Uptake and Adherence Among Adolescent Girls and Young Women at Risk of HIV Acquisition in Kampala, Uganda: A Randomized Controlled Trial"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-1818","authenticated-orcid":false,"given":"Yunia","family":"Mayanja","sequence":"first","affiliation":[{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC\/UVRI &amp; LSHTM) Uganda Research Unit  Entebbe Uganda"},{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Abaasa","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC\/UVRI &amp; LSHTM) Uganda Research Unit  Entebbe Uganda"},{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-740X","authenticated-orcid":false,"given":"Kenneth Roger","family":"Katumba","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC\/UVRI &amp; LSHTM) Uganda Research Unit  Entebbe Uganda"},{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6368-8664","authenticated-orcid":false,"given":"Matthew","family":"Spinelli","sequence":"additional","affiliation":[{"name":"Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Kikaire","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute  Entebbe Uganda"},{"name":"Department of Paediatrics College of Health Sciences Makerere University  Mulago Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7025-1994","authenticated-orcid":false,"given":"Monica","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriaki","family":"Kosidou","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"},{"name":"Centre for Epidemiology and Community Medicine  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3912-1171","authenticated-orcid":false,"given":"Anna Mia","family":"Ekstrom","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Infectious Diseases\/Vithusan  S\u00f6dersjukhuset Sweden"},{"name":"Department of Clinical Science and Education  S\u00f6dersjukhuset Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7291-1693","authenticated-orcid":false,"given":"Eugene","family":"Ruzagira","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC\/UVRI &amp; LSHTM) Uganda Research Unit  Entebbe Uganda"},{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"UNAIDS Fact Sheet 2024: Global HIV Statistics (2024). 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