Prescribing PrEP

HIV pre-exposure prophylaxis (PrEP) is highly effective in reducing transmission of HIV in high-risk populations. PrEP is available on the Pharmaceutical Benefits Scheme (PBS) via streamlined S85 monthly prescription. Any medical practitioner or qualified nurse practitioner can prescribe up to three months’ supply.

 

In Australia, the single-tablet tenofovir disoproxil + emtricitabine (TDF/FTC) is used for PrEP. Renal and BMD risks are rare for people with no preexisting renal or bone disease.

PrEP can be offered to anyone with any HIV risk.

 

Prescribing PrEP

Initiation

  • Negative HIV test - within 7 days
  • Consider PEP if risk of HIV exposure within the last 72 hours
  • EUC , confirm renal function meets guideline requirements (EGFR>60) -see ASHM Decision-Making Too
  • STI screen (throat and rectal swab + urine)
  • Perform hepatitis B serology, if status unknown, and vaccinate if not immune
  • HCV antibody

3-Monthly monitoring while on PrEP

  • HIV and syphilis serology
  • STI screen
  • EUC 6-monthly renal function

            For details, see ASHM Decision-Making Too

 

PrEP dosing options

Daily PrEP

  • Suitable for anyone
  • 1 tablet daily, commencing 7 days prior to exposure

On-Demand

  • Only suitable for cis-gender men who have sex with men
  • Not suitable for people who inject drugs
  • Take 2 tablets at least 2 hours (up to 24 hours) before sex then 1 tablet daily until 48 hours after last sexual contact
  • Diagrams and patient information 

Medicare eligible: PBS Information 

  • Prescribe Tenofovir disoproxil + emtricitabine (TDF/FTC)
  • PBS General Schedule “Restricted Benefit” - no authority required
  • 30 tablets X 2 repeats
  • Any medical officer or nurse practitioner can prescribe
  • Truvada® is no longer available on the PBS, it has been replaced by generics

Medicare ineligible

Questions? Clarifications? Contact SHIL 

 

Resources

 

Selected References

 

Further learning:

 

The Sexual Health Service makes every effort to make sure the information on this website is accurate and up to date. The guideline does not replace the need for specialist medical advice in individual cases.

If you have a printed version with a publication date, you should not rely on the document if it is more than 12 months since the publication date. You should always check website before using the guide. The web version is the only version that can be relied on as being up to date.

The information is a guide only, we do not accept any liability for any injury, loss or damage caused by use of the information provided in our website.