PrEP

Question 1

Define PrEP

Answer 1

Use of ARVs by HIV -ve who are at substantial risk of HIV acquisition before potential exposure to prevent acquisition

Question 2

What is the current preferred PrEP regimen in SA?

Answer 2

TDF/FTC FDC

Question 3

Which populations are at high risk for HIV acquisition?

Answer 3

Adolescents
Women (pregnant, BF)
MSM
Multiple partners
STI history
Sex workers
Migrant workers
Serodiscordant couples
IVDU
Anyone who requests

Question 4

What is the minimum package of services offered with PrEP?

Answer 4

HTS
Voluntary partner testing
Risk reduction counselling
Mental health counselling
Voluntary mmc
Syndromic STI management
Condoms/lubricants
Contraception
Pregnancy screening
TB screening

Question 5

Which individual characteristics increase HIV risk?

Answer 5

Sex without a condom
Multiple partners
Positive partner
Unknown status partner
Under influence of alcohol/drugs
Recent STI
Age disparate relationships (>5y)

Question 6

What are the criteria for PrEP?

Answer 6

HIV negative
Absence acute HIV infection symptoms
Willing and able to take PrEP
No contraindications to TDF/FTC
>35kg
Tanner stage 3 or more (TDF risk for hypophosphatemia)

Question 7

Name contraindications for PrEP

Answer 7

1. HIV infection
2. eGFR
   - >16yo <50
   - 10-16yo <80
3. Serum creat >85 in pregnancy

Question 8

Baseline investigations to initiate PrEP

Answer 8

HIV test
HBsAg
Syndromic STI screening
Pregnancy screening
eGFR/sCr if indicated

Question 9

What is the frequency of eGFR/sCr monitoring on PrEP?

Answer 9

Any comorbidities - baseline and annually
>30yo - baseline
Pregnancy - baseline, 3m, 6m

Question 10

What are the prescription intervals for PrEP?

Answer 10

At initiation, 1 month supply
At month 1 visit, 3 month supply
Every 3 months, 3 month supply

Question 11

When can you repeat a sCr/eGFR to reinitiate PrEP?

Answer 11

After 1-3 months

Question 12

When should you assess pregnant women for other causes of elevated sCr?

Answer 12

1. sCr >3x baseline
2. sCr continues elevating after PrEP stopped
3. sCr remains high 3 months after PrEP stopped

Question 13

What does a patient do if they miss a PrEP dose?

Answer 13

Take immediately
Continue daily doses

Question 14

Does PrEP interact with alcohol/contraceptives?

Answer 14

No

Question 15

What are minor side effects of PrEP?

Answer 15

Diarrhea
Headache
Abdominal pain
Nausea

Question 16

How do you start and stop PrEP

Answer 16

Starting - take for 7 days for full protection
Stopping - take for 7 days after last exposure

Question 17

What is the likelihood of an pregnant woman contracting HIV versus a non-pregnant woman?

Answer 17

2-3x higher

Question 18

When should PrEP be discontinued?

Answer 18

1. HIV positive
2. Persistently abnormal eGFR/sCR
3. Non-adherence
4. No longer wanted by patient

Question 19

Reasons for HIV seroconversion during PrEP?

Answer 19

Non-adherence
Non-compliance
PrEP failure

Question 20

How is eGFR measured?

Answer 20

Counahan-Barrat formula
Height (cm) x 40 / creat

Question 21

What are alternative PrEP options

Answer 21

On demand PrEP 2:1:1
F/TAF oral
Cabotegravir injection (>35kg, 1m x 2 then every 2m)
Dapivirine vaginal ring (28 days)