HIV risk, sexual behavior and PrEP uptake, adherence and discontinuation among adolescent girls and young women in low- and middle-income countries: a scoping review

Adolescent girls and young women (AGYW) bear a disproportionate burden of HIV/AIDS. Pre-exposure prophylaxis (PrEP) for HIV prevention is limited to individuals identified as high risk following a prior risk assessment. However, AGYW with epidemiologically assessed HIV risk still struggle to align PrEP use with their sexual behaviors. This review examines how HIV risk and sexual behavior influence decisions to initiate, adhere to or discontinue PrEP. A search was conducted across five databases in November 2025. The search was registered in the Open Science Framework and followed PRISMA-SCR guidelines. A thematic content analysis approach was used to synthesize findings guided by the health belief model and COM-B framework. Forty-nine articles were eligible for synthesis. Knowledge of HIV risk and sexual behaviors motivated PrEP initiation and adherence. There were consistently low adherence and high discontinuation rates among AGYW with objective HIV risk behaviors. Prevention effectiveness and adherence varied with alignment and misalignment of behavioral risk and PrEP adherence. Decisions to use the vaginal ring instead of oral PrEP aligned with individual behavior. Dynamic changes in sexual behavior during PrEP use and decisions to switch to injectable PrEP where multiple alternatives are offered may be explored to support PrEP uptake and persistence.