Box 1. Risk criteria for MSM to identify their eligibility for PrEP

High risk – recommend prescribing daily PrEP if the patient acknowledges

Having had any of the following in the last 3 months

• At least one episode of condomless anal intercourse (CLAI) with a regular HIV+ partner (not on treatment and/or detectable viral load)
• At least one episode of receptive CLAI with any casual HIV+ male partner or a male partner of unknown status
• Rectal gonorrhoea, rectal chlamydia or infectious syphilis diagnosis (during the last 3 months or at screening for PrEP)
• Methamphetamine use, which may increase the risk of HIV acquisition

AND

Being likely to have in the next 3 months (indicating sustained risk)

• Multiple episodes of CLAI with or without sharing intravenous drug equipment

Medium risk – consider prescribing daily PrEP, based on a case-by-case approach if discussion reveals

Having had any of the following in the last 3 months

• More than one episode of anal intercourse when proper condom use was not achieved (e.g. condom slipped off or broke) where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load
• (If patient uncircumcised) more than one episode of insertive CLAI where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load

AND

Being likely to have in the next 3 months (indicating sustained risk) 

• Multiple episodes of CLAI with or without sharing intravenous drug equipment

*Case-by-case approach: Based on a complete sexual and alcohol and other drug-using history and the personal circumstances of the patient, if the clinician is of the opinion that the patient is likely to be at high risk of HIV, then PrEP prescription may be considered despite the absence of reported high- or medium-risk factors above.

Box 2. Risk criteria for trans and gender diverse people to identify their eligibility for PrEP

High risk – recommend prescribing daily PrEP if the patient acknowledges

Having had any of the following in the last 3 months

• Being a regular sexual partner of an HIV+ person (not on treatment and/or detectable viral load) with whom condoms have not been consistently used
• At least one episode of receptive condomless intercourse (CLI) with any casual HIV+ partner or a male partner of unknown status
• Rectal or vaginal gonorrhoea, rectal or vaginal chlamydia or infectious syphilis diagnosis (during the last 3 months or at screening for PrEP)
• Methamphetamine use, which may increase the risk of HIV acquisition

AND

Being likely to have in the next 3 months (indicating sustained risk)

• Multiple episodes of anal or vaginal CLI with or without sharing intravenous drug equipment

Medium risk – consider prescribing daily PrEP, based on a case-by-case approach if discussion reveals

Having had any of the following in the last 3 months

• More than one episode of anal or vaginal intercourse when proper condom use was not achieved (e.g. condom slipped off or broke) and where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load
• (If patient uncircumcised) more than one episode of insertive CLAI where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load

AND

Being likely to have in the next 3 months (indicating sustained risk)

• Multiple episodes of anal or vaginal CLI with or without sharing intravenous drug equipment

*Case-by-case approach: Based on a complete sexual and alcohol and other drug-using history and the personal circumstances of the patient, if the clinician is of the opinion that the patient is likely to be at high risk of HIV, then PrEP prescription may be considered despite the absence of reported high- or medium-risk factors above.

Box 4.4 PrEP suitability criteria for people who inject drugs

HIV risk in the previous 3 months and the future 3 months

Having had any of the following in the last 3 months

• Being a regular sexual partner of an HIV+ person (not on treatment and/or with detectable viral load) with whom condoms have not been consistently used
• At least one episode of receptive anal or vaginal condomless intercourse (CLI) with any casual HIV+ partner or a male homosexual or bisexual partner of unknown status
• A female patient in a serodiscordant heterosexual relationship, who is planning natural conception in the next 3 months

AND

Being likely to have in the next 3 months (indicating sustained risk)

Multiple episodes of CLI with or without sharing intravenous drug equipment

Medium risk – consider prescribing daily PrEP, based on a case-by-case approach if discussion reveals

The patient acknowledges having had any of the following in the last 3 months

• At least one episode of CLI with a heterosexual partner, not known to be HIV–, from a country with high HIV prevalence

AND

Being likely to have in the next 3 months (indicating sustained risk)

• Multiple episodes of CLI with a heterosexual partner, not known to be HIV+, but at high risk of being HIV+ with or without sharing injecting equipment

*Case-by-case approach: Based on a complete sexual and alcohol and other drug-using history and the personal circumstances of the patient, if the clinician is of the opinion that the patient is likely to be at high risk of HIV, then PrEP prescription may be considered despite the absence of reported high- or medium-risk factors above. Specific consideration should be given to recommending PrEP to a patient who is travelling to one or more countries with high HIV prevalence and is likely to be sexually active while travelling.

Box 4. Risk criteria for PWID to identify their eligibility for PrEP

High risk – recommend prescribing daily PrEP if the patient acknowledges

Having in the last 3 months

• Shared injecting equipment with an HIV+ individual or with a gay or bisexual man of unknown HIV status

AND

Being likely to have in the next 3 months (indicating sustained risk)

• Multiple events of sharing injecting equipment with an HIV+ individual or a gay or bisexual man of unknown HIV status
• Inadequate access to safe injecting equipment