One Month Preexposure Prophylaxis Retention Rate and Associated Factors Among Adolescent Girls and Young Women Who Participated in the Namibia DREAMS Program (2018–2024)

<b>Background:</b> Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15-24 and the associated factors. <b>Methods:</b> The program's target populations for PrEP included AGYW aged 15-24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. <b>Results:</b> Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8-14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7-12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners' HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1-2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15-1.43), and COR = 2.00, 95% CI (1.62-2.46), respectively. <b>Conclusions:</b> Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences.