What is PrEP: affixed combination of antiretrovirals an effective option given to HIV negative people to prevent them from contracting HIV before potential exposure.
Who should be considered for PrEP would include any person asking for it and in particular high risk groups including:
Sex Workers
Men who have sex with men
adolescents and young women and men
migrant workers
People with a recent history of an STI
Serodiscordant couples eg if the HIV positive partner’s viral load is not suppressed
Who cannot use PrEP?
People who are HIV positive
People with poor kidney function
eg if the eGFR is less than 50ml/min
What to so if the client has symptoms or signs of HIV:
Postpone PrEP and repeat rapid HIV test after 4 weeks and if this remains negative can inititate
Switching from PEP to PrEP :
After completing 28 days PEP a client can be moved to PrEP if counselling reveals they will be at continued risk for HIV after PEP is completed.
What if the dose of PrEP is missed: The PrEP user should take the missed dose as soon as possible and continue daily.
What if the PrEP user is infected with HEP B?
TDF and FTC both have Hepatitis B antiviral activity.
PrEP users should be carefully monitored when they discontinue PrEP as discontinuation may cause serious liver damage resulting from Hep B reactivation.
Should I encourage PrEP users to also use condoms?
Yes. If PrEP is taken daily it offers protection against HIV but not against STI’s. Condoms protect against HIV, STI’s and pregnancy .
Baselines Investigations :
HIV test
Pregnancy test if female . PrEP may be offered to pregnant women at substantial risk of HIV infection
In pregnant people the serum creatinine should be less than 85 micro mol/l
STI screening
Renal Function
Hepatitis B surface Antigen
