In Zambia, adolescent girls and young women (AGYW) are at high risk of HIV prevention yet continue to have low access to pre-exposure prophylaxis (PrEP). This study shows that shifting pre-exposure prophylaxis (PrEP) services from clinics to community-based DREAMS centers substantially increased PrEP initiation, with high uptake among eligible participants. It also identifies factors associated with continued PrEP use, highlighting that decentralized, youth-friendly, and integrated support services can improve both access to and continuation of HIV prevention interventions for AGYW.