Despite demonstrated efficacy for HIV prevention, substantial challenges remain for the successful rollout of oral pre-exposure prophylaxis (PrEP), especially among adolescent girls and young women (AGYW). We characterized trajectories of PrEP adherence among 200 AGYW in South Africa and analyzed data from 22 qualitative interviews and 3 focus group discussions for explanatory purposes. Two adherence trajectory groups were identified: 52% with high early adherence that declined after month three and 48% with low adherence throughout. Adherence in the “consistently low” group was related to social support and logistical concerns, while the decrease in the “high declining” group corresponded to a change in the frequency of study visits from monthly to quarterly. PrEP support should be differentiated for those who need more frequent visits and adherence support initially versus later in PrEP use. Visits every month, when needed, should be considered for AGYW who need sustained support later into use.

尽管已证明对 HIV 预防有效，但口服暴露前预防 (PrEP) 的成功推广仍然存在重大挑战，尤其是在少女和年轻女性 (AGYW) 中。我们描述了南非 200 名 AGYW 中 PrEP 依从性的轨迹，并分析了来自 22 次定性访谈和 3 次焦点小组讨论的数据以进行解释。确定了两个依从性轨迹组：52% 的早期依从性高，但在第三个月后下降，48% 的依从性低。“持续低”组的依从性与社会支持和后勤问题有关，而“高下降”组的下降对应于学习访问频率从每月到每季度的变化。对于那些需要更频繁就诊和依从性支持的人，应将 PrEP 支持与后期使用 PrEP 的人区分开来。对于以后需要持续支持的 AGYW，应考虑在需要时每月进行一次访问。