{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:19:50Z","timestamp":1776104390733,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["72061121CA00002"],"award-info":[{"award-number":["72061121CA00002"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite being at high risk of HIV acquisition, access to pre\u2010exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS\u2010free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected individual\u2010level PrEP data for AGYW aged 15\u201324 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi\u2010squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and \u2265\u00a02 PrEP visits (i.e. an initiation plus \u2265\u00a01 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as \u2265\u00a01 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan\u2010Meier methods to estimate the time to the first PrEP return visit by client age band.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15\u201324 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow\u2010up time to allow for observation of a PrEP return visit. The proportion of AGYW who had \u2265\u00a01 PrEP return visit within 180 days of initiation was 59.0% (<jats:italic>n<\/jats:italic>\/<jats:italic>N<\/jats:italic> = 5706\/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported \u2265\u00a04 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15\u201319 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20\u201324 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26484","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:39:11Z","timestamp":1751884751000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Improving PrEP access for adolescent girls and young women: a descriptive analysis of community\u2010based PrEP delivery in the DREAMS programme in Zambia"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9968-7540","authenticated-orcid":false,"given":"Maurice","family":"Musheke","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6312-4420","authenticated-orcid":false,"given":"Jake M.","family":"Pry","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"},{"name":"School of Medicine University of California  Davis California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izukanji","family":"Sikazwe","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walusiku J.","family":"Muyunda","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanema","family":"Chiyenu","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charity M.","family":"Siame","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winfred K.","family":"Khondowe","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bwalya","family":"Mushiki","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha M.","family":"Mwaba","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pelile","family":"Zulu","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Mwape","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bridget","family":"Siamasuku","sequence":"additional","affiliation":[{"name":"Young Women Christian Association  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davies","family":"Shula","sequence":"additional","affiliation":[{"name":"Young Women Christian Association  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mable B.","family":"Mweemba","sequence":"additional","affiliation":[{"name":"Ministry of Health, Ndeke House  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cuthbert","family":"Kanene","sequence":"additional","affiliation":[{"name":"United States Agency for International Development United States of America Embassy  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arlene","family":"Phiri","sequence":"additional","affiliation":[{"name":"United States Agency for International Development United States of America Embassy  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Herce","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia (CIDRZ)  Lusaka Zambia"},{"name":"Institute for Global Health and Infectious Diseases University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Ministry of Health Zambia.Zambia Population\u2010based HIV Impact Assessment (ZAMPHIA) 2021: Final Report.Lusaka;Ministry of Health;2023."},{"key":"e_1_2_12_3_1","unstructured":"Ministry of Health.National Adolescent Health 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