{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T19:33:11Z","timestamp":1786995191973,"version":"build-2736575974"},"posted":{"date-parts":[[2026,8,14]]},"group-title":"HIV\/AIDS","reference-count":15,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000832","name":"Dowager Countess Eleanor Peel Trust","doi-asserted-by":"crossref","award":["280"],"award-info":[{"award-number":["280"]}],"id":[{"id":"10.13039\/501100000832","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Wellcome Trust PhD Programme for Primary Care Clinicians","award":["216421\/Z\/19\/Z"],"award-info":[{"award-number":["216421\/Z\/19\/Z"]}]},{"name":"Gates Foundation","award":["INV-051067"],"award-info":[{"award-number":["INV-051067"]}]},{"name":"NIH","award":["2R01AI143340"],"award-info":[{"award-number":["2R01AI143340"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Urine tenofovir (uTFV) and dried blood spot (DBS) tenofovir diphosphate (TFV-DP) concentrations respectively estimate short- and medium-term adherence to tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART). We evaluated the accuracy of a point-of-care uTFV assay, and associations between uTFV\/TFV-DP, and viral load (VL) and retention outcomes within a South African community ART programme.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We measured uTFV and DBS TFV-DP concentrations using liquid chromatography-tandem mass spectrometry (LC-MS\/MS). We calculated sensitivity and specificity of the point-of-care uTFV assay at the manufacturer-recommended threshold of \u22651,500 ng\/mL compared to LC-MS\/MS. We assessed associations of the point-of-care uTFV assay, and DBS TFV-DP concentrations with concurrent viraemia, and with retention-in-care by 16 weeks post-enrolment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 196 adults median age was 44 years, 127 (64.8%) were female, and 191 (97.4%) were receiving TDF. 185 (94.4%) had detectable point-of-care uTFV, which had high sensitivity (99.5%, 95% CI 96.5-100%) and moderate specificity (76.9%, 95% CI 46.0-93.8%) for detecting uTFV \u22651,500 ng\/mL. Two participants had concurrent viraemia \u22651,000 copies\/mL; of these 50.0% (95% CI 9.4-90.5) had undetectable point-of-care uTFV, and 100% (95% CI 19.7-100) had low TFV-DP &lt;483 fmol\/punch. Among participants without viraemia 97.4% (95% CI 93.6-99.0) had detectable uTFV, and 98.1% (95.3-99.6) had high TFV-DP \u2265483 fmol\/punch. Point-of-care uTFV and DBS TFV-DP were not associated with retention-in-care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The point-of-care uTFV assay demonstrated high sensitivity and moderate specificity to detect uTFV. Over 95% of people without viraemia had detectable point-of-care uTFV or high DBS TFV-DP levels respectively, but these were not associated with 16-week retention-in-care.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.08.13.26360358","type":"posted-content","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:30:18Z","timestamp":1786739418000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of point-of-care urine tenofovir test, and associations between metrics of tenofovir use and treatment outcomes in a community ART programme"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8516-4554","authenticated-orcid":false,"given":"Lisanthini","family":"Naidu","sequence":"first","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-9146","authenticated-orcid":false,"given":"Kwena","family":"Tlhaku","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"},{"name":"Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katya","family":"Govender","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute (AHRI), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9029-5153","authenticated-orcid":false,"given":"Yukteshwar","family":"Sookrajh","sequence":"additional","affiliation":[{"name":"eThekwini Municipality primary Health Care Services Directorate, Durban, South 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Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-2086","authenticated-orcid":false,"given":"Lara","family":"Lewis","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Drain","sequence":"additional","affiliation":[{"name":"Departments of Medicine, Epidemiology, and Global Health, University of Washington, Seattle, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C","family":"Butler","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Hayward","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4530-234X","authenticated-orcid":false,"given":"Nigel","family":"Garrett","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"},{"name":"Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa"},{"name":"Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6072-1430","authenticated-orcid":false,"given":"Jienchi","family":"Dorward","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"issue":"1","key":"2026081711450763000_2026.08.13.26360358v1.1","doi-asserted-by":"crossref","first-page":"21484","DOI":"10.7448\/IAS.19.1.21484","article-title":"Reimagining HIV service delivery: the role of differentiated care from prevention to suppression","volume":"19","year":"2016","journal-title":"Journal of the International AIDS 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