<![CDATA[Although Pre-Exposure Prophylaxis (PrEP) exhibits high efficacy in HIV prevention, uptake and adherence rates among Female Sex Workers (FSWs) remain low due to stigma, side effects, and inaccurate self-reported monitoring. Objective: This study aims to explore and identify the most effective approaches to enhance PrEP adherence and adherence monitoring systems among FSWs. Methods: An integrative research review design following PRISMA guidelines was employed. A systematic search was conducted across Scopus, PubMed, EBSCO, and Sage Journal databases for articles published between 2020 and 2026. Quality appraisal was evaluated using the 2018 Mixed Methods Appraisal Tool (MMAT). Findings: Out of 446 identified records, 7 articles met the inclusion criteria. Findings indicate that the most effective strategy to optimize adherence is a combined approach integrating mHealth interventions (such as the Jichunge smartphone app for reminders and education), peer support (peer navigators), and individualized case management. Furthermore, the most reliable adherence monitoring framework combines biological assays (tenofovir plasma/DBS biomarkers) and electronic monitoring (EAM/Wisepill) to mitigate social desirability bias inherent in self-reports. Implications: Healthcare providers and policymakers should implement integrated intervention models incorporating digital innovations, peer community empowerment, and objective monitoring tools to sustain long-term retention and effectiveness of PrEP programs among FSWs.]]>
