<p>Post-exposure prophylaxis (PEP) is a crucial human immunodeficiency virus (HIV) prevention tool, yet utilization among men who have sex with men (MSM) remains suboptimal. This study aimed to describe the longitudinal trends in PEP utilization and identify factors associated with recent PEP utilization. A prospective cohort study enrolled 497 MSM in Qingdao between January and July 2023. Participants underwent baseline assessment and were followed up every 6 months, collecting data on sociodemographic characteristics, sexual behaviors, and health service utilization. This analysis included participants who completed all four assessments. Temporal trends were assessed using the chi-square test for trends. Generalized Estimating Equations (GEE) with a logit link were used to identify factors associated with recent PEP use. A total of 417 MSM were included in the analysis. Over the follow-up period, ever PEP use showed a non-significant increasing trend (32.1% to 36.2%). Conversely, recent PEP use significantly decreased from 5.3% at baseline to 2.6% at final follow-up. Multivariable GEE analysis indicated that higher proportions of recent PEP use were associated with engagement in commercial sex, recent sexually transmitted infections diagnosis, prior PrEP use, and perceiving PEP as effective. Lower proportions were associated with age ≥ 30 years and frequent HIV testing. Although ever PEP use appears relatively high among MSM in Qingdao, recent PEP utilization is low and has declined significantly over time. These findings suggest the need for tailored strategies to sustain and optimize PEP use as part of a comprehensive HIV prevention package.</p>