Assessing the multifaceted factors influencing HIV Pre-Exposure Prophylaxis (PrEP) uptake and continuation among young women aged 15–24 years in Kampala, Uganda.

Despite being recognized as a highly cost-effective HIV prevention strategy, pre-exposure prophylaxis (PrEP) uptake and continuity remain suboptimal among young women, highlighting the urgent need to address underlying barriers and logistical challenges hindering access and utilization of this preventive measure. Maintaining continuity is essential because PrEP’s effectiveness depends heavily on adherence and consistent access. This study examined the factors affecting PrEP adherence among young women aged 15–24. Andersen’s Behavioral Model (ABM) provided a vital framework for analyzing PrEP continuity. The hypothesis is that an individual’s decision to use PrEP is driven by personal characteristics, need, and access. Secondary data were abstracted from routine data for clients seeking HIV prevention services at the Mulago National Referral Hospital’s STI clinic. All data were analyzed using Stata IC 16.0. A total of N = 2495 young women were on PrEP from January 2024 to September 2025. This study revealed critically low PrEP continuation rates among young women in Uganda, with only 6.48% remaining on PrEP at 12 months despite substantial HIV risk in this population. There was a significant difference in continuation rates between facility-based (74.88 per 100 person-years) and community-based (11.04 per 100 person-years) service delivery. The findings suggest consideration for hybrid models that combine community outreach for awareness and screening with facility-based initiation and early support. Enrolled clients on PrEP need intense adherence counseling to improve continuity rates.