Journal of Reproductive Health, Gender, and HIV in Africa | 09 May 2004
A Case Study of Event-Driven Pre-Exposure Prophylaxis Continuation Rates over 12 Months among University Students in Pretoria
C, a, r, o, l, F, i, s, h, e, r, ,, T, h, a, n, d, i, w, e, v, a, n, d, e, r, M, e, r, w, e, ,, M, i, s, s, S, i, a, n, W, i, l, l, i, a, m, s
Abstract
Event-driven pre-exposure prophylaxis (PrEP) is a recommended HIV prevention strategy for individuals with infrequent or predictable sexual activity. There remains limited real-world evidence on the continuation rates of this regimen among young adults in sub-Saharan African university settings, where sexual activity can be episodic. This case study aimed to determine the 12-month continuation rate for event-driven PrEP among university students in Pretoria, South Africa, and to identify factors influencing its ongoing use. A retrospective case review was conducted using clinical records from a university health service PrEP programme. Data were extracted for all students who initiated event-driven PrEP and had at least one opportunity for follow-up over a 12-month period. Continuation was operationally defined as the collection of PrEP refills or attendance at scheduled consultations. The 12-month continuation rate was 42%. Analysis of clinical notes indicated that discontinuation was frequently associated with a perceived low risk of HIV acquisition during periods of high academic workload or holidays, rather than side effects or difficulties with access. Continuation of event-driven PrEP in this student cohort was suboptimal, declining substantially over one year. Discontinuation appeared closely linked to dynamic, perception-based risk assessment rather than structural barriers alone. PrEP programmes should integrate more frequent, proactive risk-reassessment counselling during follow-up visits. Tailored support, potentially delivered via digital platforms, is needed during periods students perceive as low-risk to encourage PrEP persistence. HIV prevention, pre-exposure prophylaxis, PrEP, event-driven PrEP, on-demand PrEP, adherence, continuation, university students, South Africa This case study provides practical insights into the challenges of sustaining event-driven PrEP use among African university students, informing the adaptation of youth-focused PrEP service delivery.