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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 to adhere to a regimen that has been shown to be efficacious and who express a willingness to do so.

Adherence to PrEP should be assessed at each follow-up visit. PrEP users who explain that they have had suboptimal adherence, but who are willing and suitable to continue on PrEP, should be offered additional adherence education (see Medication adherence, including offering referral to peer-based support services). If a PrEP user repeatedly reports adherence that is sufficiently suboptimal to compromise both PrEP’s efficacy (i.e. fewer than four tablets per week when taking a daily regimen) and the patient’s safety, the clinician should discontinue prescribing PrEP. See also Chapter 9. nPEP and PrEP for the course of action to follow if a patient is not adherent to PrEP and has had a risk of exposure in the last 72 hours.

PrEP script duration including extension of PrEP scripts

The initial and ongoing prescriptions should offer a 90-day medication supply. PrEP scripts can be dispensed and filled on the same day as the baseline HIV test is done as long as the clinician is confident that the pathology service they use will provide a 4th generation HIV test result within 24-48 hours, at which time HIV antiretroviral treatment can be offered if the HIV test is found to be positive.

Typically, PrEP prescriptions should cover no more than 90 days of TD*/FTC supply at a time. Scripts can be provided and dispensed before the repeat quarterly HIV test results are available. However, people who are travelling overseas for prolonged periods may be given more than 90 days supply of PrEP, but the patient should agree to undergo HIV and STI testing at the usual 90-day period when they are overseas and to provide the results to their PrEP prescriber in Australia. People who use on-demand^† PrEP should also present for HIV and STI testing on a quarterly basis even if they do not need a prescription refill at that time.

^† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.