Clinical follow-up and monitoring of patients on PrEP
HIV testing should be repeated every 3 months using a fourth generation HIV antibody and antigen test via a venous blood draw. Rapid point-of-care tests, including the recently approved home testing HIV diagnostic kit, the Atomo HIV Self Test, should not be used for monitoring patients receiving PrEP.
A patient’s ongoing HIV risk and adherence to PrEP should be established when requesting the patient presents for their quarterly clinical visit including the HIV test and PrEP script (see Improving medication adherence). Patients should be familiar from their baseline visit with the requirement for quarterly clinical visits to obtain ongoing PrEP prescriptions. Clinicians should consider writing on ongoing PrEP prescriptions a date past which dispensing the script should not occur without the pharmacist talking to both the patient and the prescribing doctor about the reasons for the delay in filling the script. This approach may help ensure that patients who have had intermittent PrEP adherence and who have unknowingly acquired HIV infection do not receive 3 months of suboptimal antiretroviral treatment.
See Appendix 2 for up-to-date HIV tests approved in Australia (K Wilson, National Serum Reference Library, personal communication) and time to detection of HIV infection (2).