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To examine patterns of long-term PrEP adherence and its association with HIV seroconversion in NSW, Australia. Population-based HIV PrEP implementation study. EPIC-NSW was an open-label study of daily oral PrEP which recruited participants from March 2016 to April 2018. Adherence was measured using dispensing records. PrEP discontinuation was defined as a ≥120-day period without PrEP coverage. Long-term adherence patterns were identified using group-based trajectory modelling. Participants dispensed at least once (n = 9586) were almost a