The RECOPE study evaluated adherence to oral PrEP among 657 users in China who purchased it online, with a response rate of 96.6% at baseline and 80.1% at 6 months. Of the 621 users, 85.2% started with the event-driven (ED) “2-1-1” mode and 14.8% started with the daily mode. Among ED users, optimal adherence was 41.3–52.6% across the four time points, while for daily users it was 81.4–87.8% with a mean rate of 97.1–98.7% over the past month. Older age, receptive or versatile sex role, and higher self-efficacy were positively associated with adherence in ED users, while multiple same-sex partners, chemsex, and PrEP-related stigma were negative factors. The study identified limitations such as selection bias and recall bias. It suggests targeted interventions to improve understanding of instructions, promote self-efficacy, and reduce stigma, especially among ED users with chemsex, advertising anal sex, multiple partners, or younger age.