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 HIV acquisition. Only co-formulated tenofovir and emtricitabine (TD*/FTC) is licensed in Australia for use as PrEP and is the only regimen that should be used.
- educate patients about the medications and the dosing regimen (daily for all patients, or on-demand† for cis-gender men who have sex with men (MSM)) to optimise safe medication use.
- provide counselling on sexually transmissible infections (STIs) and their prevention.
- provide medication-adherence support and counselling to help patients achieve and maintain protective levels of medication.
- provide HIV risk-reduction support and offer harm reduction including referrals to help patients minimise their risk of acquiring HIV, viral hepatitis B and C and STIs.
- provide effective contraception to women who are taking PrEP and who do not wish to become pregnant.
- monitor patients on a quarterly basis to screen for HIV infection, STIs and toxicity and to determine whether PrEP remains indicated.
PrEP licensing in Australia
Co-formulated TD*/FTC is registered by the Therapeutic Goods Administration (TGA) for daily use and is subsidised by the Pharmaceutical Benefits Scheme (PBS) in Australia. A clinicians provision of on-demand PrEP requires off-label prescribing.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.