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HIV Guidelines

New rapid guidance: Six-month oral PrEP prescribing

Medical and nurse practitioners can now prescribe up to a six-month supply of oral PrEP in the form of tenofovir disoproxil + emtricitabine on a single prescription following changes to the PBS. Read the rapid guidance here.

PrEP suitability criteria for heterosexuals

This section addresses PrEP suitability for heterosexuals. This section is relevant to the following populations: (i) people who were assigned female at birth (cis-female), identify as female and as heterosexual; (ii) people who were assigned male at birth (cis-male), identify as male and identify as heterosexual; (iii) people who were assigned male at birth (cis-male), identify as female (trans-female) and identify as heterosexual and (iv) people who were assigned female at birth (cis-female), identify as male (trans-male) and identify as heterosexual.

Box 14.2PrEP suitability criteria for heterosexuals
HIV risk in the previous 3 months and the future 3 months The clinician should prescribe PrEP if the patient describes a history of any of the following HIV acquisition risks in the previous 3 months and if the patient foresees that there are likely to be similar acquisition risks in the next 3 months.
  • At least one episode of condomless anal or vaginal intercourse (insertive or receptive) with a regular HIV-positive partner who is either not on treatment, or who is on treatment but has a detectable HIV viral load
  • At least one episode of receptive anal or vaginal condomless intercourse with any casual HIV-positive partner or a male bisexual partner of unknown status
  • Episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load.
HIV risk in the future 3 months The clinician should prescribe PrEP if the patient foresees that they will have HIV acquisition risk in the upcoming 3 months, despite not having had HIV acquisition risk in the previous 3 months:
  • Future episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load
  • When a person plans to travel to countries with high HIV prevalence during which time they anticipate having condomless sex with casual partners who are HIV positive or of unknown HIV serostatus
  • When a person plans to return home to an overseas country which has a high HIV prevalence during which time they anticipate that they will be having condomless sex with casual partners
  • When a person reports that they have recently left a monogamous relationship and will be having condomless sex with a casual HIV-positive partner, or a male or female partner of unknown HIV serostatus from a country with high HIV prevalence, or a male partner who is thought to have sex with men
  • When an individual reports that they will be entering, or leaving institutional or correctional facilities in the near future where they may have condomless sex with HIV+ or gay or bisexual male casual partners in the future
  • When a person presents with concerns of deteriorating mental health and a history of having had increased their HIV acquisition risk behaviour in this setting
  • When a person presents with a history of intermittent binge drinking of alcohol or recreational drug use and a history of having had increased their HIV acquisition risk behaviour in this setting.
The clinician should consider prescribing PrEP also in the following circumstances:
  • When an HIV serodiscordant couple experience undue suffering and anxiety about inter-couple HIV transmission despite the positive partner being virologically suppressed on treatment.
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