{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T21:26:26Z","timestamp":1785101186562,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brazilian National Council for Scientific and Technological Development","award":["141796\/2019-7"],"award-info":[{"award-number":["141796\/2019-7"]}]},{"name":"Unitaid","award":["#2017-15-FIOTECPrEP"],"award-info":[{"award-number":["#2017-15-FIOTECPrEP"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Consistent monitoring of PrEP adherence with accurate measurement tools at point-of-care could greatly contribute to reaching adolescents with poor adherence. We aimed to assess the performance of indirect adherence measures to oral PrEP among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>PrEP15-19 is a prospective, multicenter, PrEP demonstration cohort study that includes AMSM and ATGW aged 15\u201319 in three Brazilian cities. A diagnostic accuracy study was conducted using tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots as the reference standard, along with three index tests: medication possession ratio (MPR), pill count, and self-report. We calculated the area under the curve (AUC) for protective TFV-DP levels (\u2265800 fmol\/punch) and sensitivity (SE) and specificity (SP) for established cutoff points.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 302 samples from 188 participants. Most of participants were AMSM (78.7%), aged 18\u201319 years (80.3%), and non-whites (72.9%). The AUC was 0.59 for MPR, 0.69 for pill count, and 0.75 for self-report. When combining MPR and self-report, the AUC increased to 0.77. Sensitivity was high for the cutoff points identified by the Youden index, 80% for MPR, 92% for self-report, and 97% for pill count. However, specificities were low 40%, 46%, and 38%, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Indirect measures were able to discriminate adolescents with good adherence. However, their performance in identifying those with low adherence might be limited, suggesting that it is necessary to initiate adherence interventions when there is no evidence of perfect adherence. Combining measures can provide wider information on adherence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310861","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T18:30:56Z","timestamp":1735669856000},"page":"e0310861","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Performance of indirect adherence measures for daily oral pre-exposure prophylaxis for HIV among adolescent men who have sex with men and transgender women in Brazil"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-765X","authenticated-orcid":true,"given":"Diana","family":"Zeballos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laio","family":"Magno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiane","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jony Arrais","family":"Pinto Junior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Amorim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirceu","family":"Greco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Grangeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Dourado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of The PrEP15-19 study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"issue":"1","key":"pone.0310861.ref001","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/QAI.0000000000001179","article-title":"An HIV Preexposure Prophylaxis Demonstration Project and Safety Study for Young MSM.","volume":"74","author":"SG Hosek","year":"2017","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"11","key":"pone.0310861.ref002","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1001\/jamapediatrics.2017.2007","article-title":"Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States","volume":"171","author":"SG Hosek","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"8","key":"pone.0310861.ref003","doi-asserted-by":"crossref","first-page":"e502","DOI":"10.1016\/S2352-3018(21)00127-2","article-title":"Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study.","volume":"8","author":"R Schaefer","year":"2021","journal-title":"Lancet HIV"},{"key":"pone.0310861.ref004","article-title":"Portaria No21, de 25 de maio de","author":"Secretaria de Ci\u00eancia, Tecnologia e Insumos Estrat\u00e9gicos, Minist\u00e9rio da Sa\u00fade.","year":"2017","journal-title":"Torna p\u00fablica a decis\u00e3o de incorporar o tenofovir associado a entricitabina (TDF\/FTC 300\/200mg) como profilaxia pr\u00e9-exposi\u00e7\u00e3o (PrEP) para"},{"key":"pone.0310861.ref005","article-title":"Protocolo cl\u00ednico e diretrizes terap\u00eauticas para Profilaxia Pr\u00e9-exposi\u00e7\u00e3o (PrEP) de risco \u00e0 infec\u00e7\u00e3o pelo HIV.","author":"Brasil","year":"2022","journal-title":"Minist\u00e9rio da Sa\u00fade Bras\u00edlia"},{"issue":"9","key":"pone.0310861.ref006","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study","volume":"14","author":"RM Grant","year":"2014","journal-title":"Lancet Infect Dis"},{"issue":"151","key":"pone.0310861.ref007","doi-asserted-by":"crossref","first-page":"151ra125","DOI":"10.1126\/scitranslmed.3004006","article-title":"Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men.","volume":"4","author":"PL Anderson","year":"2012","journal-title":"Sci Transl Med."},{"issue":"3","key":"pone.0310861.ref008","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/QAI.0000000000002876","article-title":"Understanding Pre-Exposure Prophylaxis Adherence in Young Women in Kenya.","volume":"89","author":"JE Haberer","year":"2022","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"2","key":"pone.0310861.ref009","doi-asserted-by":"crossref","first-page":"e25223","DOI":"10.1002\/jia2.25223","article-title":"Pre\u2010exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study.","volume":"22","author":"DP Wheeler","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"pone.0310861.ref010","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/S2352-3018(22)00030-3","article-title":"Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis","volume":"9","author":"J Zhang","year":"2022","journal-title":"Lancet HIV"},{"key":"pone.0310861.ref011","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2147\/PPA.S248696","article-title":"Real-Time Monitoring and Point-of-Care Testing: A Review of the Current Landscape of PrEP Adherence Monitoring.","volume":"15","author":"A Hannaford","year":"2021","journal-title":"Patient Prefer Adherence"},{"issue":"1","key":"pone.0310861.ref012","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s10461-012-0172-7","article-title":"A proposal for quality standards for measuring medication adherence in research","volume":"17","author":"AB Williams","year":"2013","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0310861.ref013","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1056\/NEJMra050100","article-title":"Adherence to medication","volume":"353","author":"L Osterberg","year":"2005","journal-title":"N Engl J Med"},{"issue":"8","key":"pone.0310861.ref014","first-page":"1","article-title":"Performance of HIV pre-exposure prophylaxis indirect adherence measures among men who have sex with men and transgender women: Results from the PrEP BrasIL study.","volume":"14","author":"LMS Marins","year":"2019","journal-title":"PLoS One."},{"issue":"4","key":"pone.0310861.ref015","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s13142-015-0315-2","article-title":"Self-report measures of medication adherence behavior: recommendations on optimal use.","volume":"5","author":"MJ Stirratt","year":"2015","journal-title":"Transl Behav Med."},{"issue":"July","key":"pone.0310861.ref016","first-page":"1","article-title":"Comparing Self-Report Pre-Exposure Prophylaxis Adherence Questions to Pharmacologic Measures of Recent and Cumulative Pre-Exposure Prophylaxis Exposure.","volume":"10","author":"J Blumenthal","year":"2019","journal-title":"Front Pharmacol."},{"issue":"7","key":"pone.0310861.ref017","first-page":"295","article-title":"HIV Pre-Exposure Prophylaxis for Conception Among HIV Serodiscordant Couples in the United States: A Cohort Study.","volume":"34","author":"AA Leech","year":"2020"},{"issue":"4","key":"pone.0310861.ref018","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1007\/s10461-017-1958-4","article-title":"Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data.","volume":"22","author":"Z Baker","year":"2018","journal-title":"AIDS Behav"},{"issue":"suppl 1","key":"pone.0310861.ref019","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311xen143221","article-title":"Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil.","volume":"39","author":"I Dourado","year":"2023","journal-title":"Cad Saude Publica"},{"issue":"1","key":"pone.0310861.ref020","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01710-17","article-title":"Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots following Directly Observed Therapy","volume":"62","author":"PL Anderson","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"pone.0310861.ref021","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/QAI.0000000000002354","article-title":"Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots Following Tenofovir Alafenamide: The TAF-DBS Study.","volume":"84","author":"J Yager","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0310861.ref022","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","article-title":"Sample size estimation in diagnostic test studies of biomedical informatics.","volume":"48","author":"K. Hajian-Tilaki","year":"2014","journal-title":"J Biomed Inform"},{"issue":"8","key":"pone.0310861.ref023","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1177\/0962280216680383","article-title":"The choice of methods in determining the optimal cut-off value for quantitative diagnostic test evaluation","volume":"27","author":"K. Hajian-Tilaki","year":"2018","journal-title":"Stat Methods Med Res."},{"key":"pone.0310861.ref024","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2307\/2533958","article-title":"Nonparametric analysis of clustered ROC curve data","author":"NA Obuchowski","year":"1997","journal-title":"Biometrics"},{"key":"pone.0310861.ref025","first-page":"1","article-title":"Estimating the area under a receiver operating characteristic curve for repeated measures design.","volume":"8","author":"H Liu","year":"2003","journal-title":"J Stat Softw."},{"issue":"5","key":"pone.0310861.ref026","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/QAI.0000000000000216","article-title":"Study product adherence measurement in the iPrEx placebo-controlled trial: concordance with drug detection.","volume":"66","author":"KR Amico","year":"2014","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"suppl 1","key":"pone.0310861.ref027","article-title":"Building bridges to care: the experience of peer navigation in enabling linkage to PrEP for adolescent men who have sex with men and transgender women.","volume":"39","year":"2023","journal-title":"Cad Saude Publica"},{"issue":"7","key":"pone.0310861.ref028","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/QAD.0000000000001024","article-title":"Comparison of subjective and objective adherence measures for preexposure prophylaxis against HIV infection among serodiscordant couples in East Africa","volume":"30","author":"N Musinguzi","year":"2016","journal-title":"AIDS"},{"issue":"4","key":"pone.0310861.ref029","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s10461-017-1951-y","article-title":"Utility of Different Adherence Measures for PrEP: Patterns and Incremental Value","volume":"22","author":"A Abaasa","year":"2018","journal-title":"AIDS Behav"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310861","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T18:31:14Z","timestamp":1735669874000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310861"}},"subtitle":[],"editor":[{"given":"Fengyi","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,12,31]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310861","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,31]]}}}