Pre-exposure prophylaxis (PrEP) medications are registered in Australia with the Therapeutic Goods Administration (TGA) and they are subsidised by the Australian Pharmaceutical Benefits Scheme (PBS). All general practitioners, other medical specialists, and authorised nurse practitioners can prescribe PrEP using a PBS streamlined authority arrangement. No specialist training is required to prescribe PrEP, however resources and training guidance are available for clinicians who are new to prescribing PrEP.
People presenting for PrEP are typically at high risk of human immunodeficiency virus (HIV) infection and they should not be dissuaded from using PrEP. To do so is to deny a person access to one of the most effective HIV prevention tools currently available. Doctors and authorised nurse practitioners who are not comfortable prescribing PrEP should refer the patient immediately to a colleague, or another service that does provide PrEP.
It should also be highlighted that sexual history taking is a necessary and routine part of medical practice, and when this process identifies that a patient may be at risk of HIV, clinicians should proactively offer these patients PrEP. Furthermore clinicians are encouraged to raise PrEP as an HIV prevention strategy with patients whom they perceive to be at risk of HIV infection, even if the purpose of the patient’s visit is not related to sexual health, sexually transmissible infections (STIs) or drug use.
These ASHM 2021 PrEP guidelines recommend daily PrEP for all people at risk of HIV infection. In addition, these guidelines also recommend that on-demand† PrEP should be offered as an alternative option to cis-gender men who have sex with men (MSM). Please refer to section Providing PrEP for further information on initiating PrEP.
PrEP providers need to obtain a thorough sexual and drug-use history at baseline to determine a person’s suitability for PrEP and to review their ongoing need for PrEP at each 3-monthly clinical review. It is important to acknowledge that a person’s behaviour may change over time, and that a person may wish to continue PrEP even if their current HIV acquisition risk is not high.
These guidelines acknowledge that PrEP should be recommended as an HIV prevention strategy for people who have been at risk of HIV infection during the previous 3 months and who foresee having similar risks in the next 3 months. These guidelines also recommend PrEP for people who have not been at risk of HIV infection during the previous 3 months, but whose circumstances have changed, and they foresee HIV risk occurring in the next 3 months.
Please note that people who are eligible for PrEP based on their sexual behaviour may be simultaneously eligible for PrEP based on their injecting and other drug use behaviour and vice versa.
The following suitability criteria can be used to help structure a discussion with a patient about their sexual health and behaviour. Guidance on how to initiate and guide a discussion about a person’s sexual and drug using behaviour in primary practice is available (1).
Clinicians who have limited experience with prescribing PrEP are encouraged to discuss with a PrEP experienced clinician those patients whose PrEP suitability is unclear.
For clinicians who are skilled at and who prefer to evaluate people’s PrEP suitability according to how the person reports their gender identity and sexuality, please refer to the alternative Suitability for PrEP chapter.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.