Goals of PrEP
The ultimate goal of HIV pre-exposure prophylaxis (PrEP) is to reduce the acquisition of HIV infection and its resultant morbidity, mortality and associated cost to individuals and society. Therefore, clinicians initiating the provision of PrEP should: prescribe medication regimens that are proven safe and effective for HIV-negative people who are suitable for PrEP to reduce their risk of […]
Daily PrEP
Daily PrEP is the most commonly prescribed PrEP regimen in Australia. Daily use of TD*/FTC is highly efficacious at preventing HIV transmission in MSM 1, 2, heterosexuals 3, transgender women 4 and people who inject drugs (PWID) 5 in the setting of high medication adherence. A detailed review of these and other studies that have demonstrated the efficacy […]
On-demand PrEP†
On-demand† PrEP involves taking two tablets of TD*/FTC 2–24 hours before a potential sexual exposure to HIV, followed by a third tablet 24 hours after the first dose and a fourth tablet 48 hours after the first dose. If sex continues beyond one day, a user of on-demand† PrEP can stay protected by continuing to take a […]
The choice of PrEP schedule: daily versus on-demand PrEP
Daily PrEP is suitable for all people who are at risk of HIV. Daily PrEP is the only PrEP regimen that is recommended for cisgender women, transgender women on exogenous oestrogen therapy, transgender men who have vaginal sex, and for people who inject drugs (PWID) 6. The Therapeutic Goods Administration (TGA) has not approved this […]
Injectable PrEP
Introduction and the Australian Context: On the 8th of August 2022, the Australian Therapeutic Goods Administration (TGA) approved the use of long-acting injections of cabotegravir (CAB-LA) as HIV pre-exposure prophylaxis (PrEP) for adults and adolescents with HIV acquisition risk (for those at least 12 years of age and weighing at least 35 kg). In September […]
Other PrEP dosing schedules
There is some online guidance currently available that recommends that MSM taking PrEP can use a dosing schedule where they take a single dose of PrEP on Tuesdays, Thursdays, Saturdays and Sundays, known as ‘the Ts and Ss’. While the motive for simplifying the PrEP dosing schedule is laudable the ASHM PrEP Guidelines Panel does not recommend the […]
Evaluation of the need for ongoing PrEP
Along with encouraging safer sex practices and safer injecting techniques, as needed, clinicians should support their patients to decide when to commence PrEP and when to discontinue its use. The duration of PrEP use will depend on whether the person’s risk of HIV continues over time. PrEP should only be prescribed to those patients who are able […]
Laboratory and clinical follow-up schedule at baseline and follow-up
The recommended schedule of testing and follow-up of people on PrEP is outlined in the Table 7.1 in Clinical follow-up and monitoring of patients on PrEP.
Indicated medication
The medications proven safe and effective, and currently approved by the TGA for PrEP in healthy adults at risk of acquiring HIV infection, are the fixed-dose combination of TD* and FTC in a single daily dose. Therefore, TD*/FTC or other generic versions of TD*/FTC are the recommended medications that should be prescribed for PrEP for […]
What not to use for PrEP
DO NOT use any HIV antiretroviral medications, either in place of, or in addition to TD* or FTC. Do not provide PrEP as expedited partner therapy (i.e. do not prescribe for a person who is not in your care).