A Case Study of Event-Driven Pre-Exposure Prophylaxis Continuation Rates over 12 Months among University Students in Pretoria

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.