The effectiveness of point-of-use water treatment may be limited by declining use over time, particularly when water treatment is introduced via targeted intervention programmes. In order to evaluate the long-term uptake and use of locally produced ceramic water filters in rural Cambodia, we visited households that had received filters as part of NGO-subsidized distribution programmes over a 4 year period from 2002 to 2006. Of the more than 2,000 filters distributed, we visited 506 randomly selected households in 13 villages spanning three provinces to assess filter time in use and to collect data on factors potentially correlated with long-term use. Results indicate that filter use declined at the rate of approximately 2% per month after implementation, largely owing to breakages, and that, controlling for time since implementation, continued filter use over time was most closely positively associated with: related water, sanitation and hygiene practices in the home; cash investment in the technology by the household; and use of surface water as a primary drinking water source.