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Provides guidance for identifying indications and assessing HIV acquisition risk across sexual exposure, injection practices, and specific populations. 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This manual is a resource for internal use only. Should questions about content or process arise, please contact:  \nEric S. Mayes  \nVDH PrEP Coordinator  \n[eric.mayes@vdh.virginia.gov](eric.mayes@vdh.virginia.gov)  \n(804)-763-9506  \nWebsite:  \n[http://www.vdh.virginia.gov/disease-prevention/prep-and-npep/](http://www.vdh.virginia.gov/disease-prevention/prep-and-npep/)  \n[For information about the VDH](For information about the VDH nPEP program)[ ](For information about the VDH nPEP program)[nPEP](For information about the VDH nPEP program)[ program](For information about the VDH nPEP program) ([non-occupational post-exposure](non-occupational post-exposure)[ ](non-occupational post-exposure)prophylaxis), please contact Eric Mayes or visit the website for the nPEP Protocols for Local Health Departments and additional resources.  \nTABLE OF CONTENTS  \nACRONYMS _______________________________________________________________________ 6  \nINTRODUCTION ___________________________________________________________________ 7  \nCLINICAL PrEP GUIDELINES ________________________________________________________ 9  \nIDENTIFYING INDICATIONS FOR PrEP _________________________________________ 9  \nTable 1: PrEP Indications: Identifying Substantial Risk of Acquiring HIV Infection___________9  \nFigure 1: Assessing Indications for PrEP in Sexually Active Persons______________________ 11  \nASSESSING RISK OF SEXUAL HIV ACQUISITION ______________________________ 11  \nPartner(s) with HIV or Unknown HIV Status ________________________________________11  \nPersons with History of a Bacterial STI in the Past 6 Months____________________________ 11  \nPersons with Inconsistent or No Condom Use________________________________________12  \nASSESSING RISK OF HIV ACQUISITION THROUGH INJECTION PRACTICES_______ 12  \nPersons Who Inject Drugs _______________________________________________________12  \nFigure 2: Assessing Indications for PrEP in Persons Who Inject Drugs ____________________ 13  \nASSESSING RISK OF HIV IN SPECIFIC POPULATIONS __________________________ 13  \nTransgender Persons ___________________________________________________________13  \nPersons with Renal Disease ______________________________________________________14  \nTable 2: PrEP Medication Options Based on Estimated Creatinine Clearance _______________ 14  \nAdolescents __________________________________________________________________14  \nWomen Who Become Pregnant or Breastfeed While Taking PrEP________________________ 14  \nHIV Discordant Partnerships _____________________________________________________14  \nPersons with Documented HIV Infection ___________________________________________15  \nTable 3: Summary of CDC Guidance for Daily Oral PrEP Use __________________________ 16  \nLABORATORY TESTING_____________________________________________________ 16  \nHIV Testing __________________________________________________________________16  \nFigure 3: Determination of HIV Status for Persons without Recent PrEP Use _______________ 17  \nFigure 4: Determination of HIV Status for Persons with Recent PrEP Use__________________ 18  \nAcute HIV Infection Assessment__________________________________________________18  \nSTI Testing___________________________________________________________________18  \nRenal Function________________________________________________________________19  \nFigure 5: Cockgroft-Gault Formula to Determine eCrCl________________________________ 19  \nLipid Profile for F/TAF Users ____________________________________________________19  \nHepatitis B Testing and/or Vaccination_____________________________________________19  \nHepatitis C Testing_____________________________________________________________20  \nTesting N","cbCaihT2Ee7zDEvH","https://ap.wps.com/l/cbCaihT2Ee7zDEvH","pdf",7959483,101,"English","# Acronyms\n# Introduction\n# Clinical PrEP Guidelines\n## Identifying Indications for PrEP\n## Assessing Risk of Sexual HIV Acquisition\n## Assessing Risk of HIV Acquisition Through Injection Practices\n## Assessing Risk of HIV Acquisition in Specific Populations\n## Laboratory Testing\n## Prescribing PrEP and Documenting Visits\n## CABOTEGRAVIR (CAB, brand name Apretude)","[{\"question\":\"What is this PrEP Clinic Resource Manual intended for?\",\"answer\":\"It is intended for internal use by entities affiliated with the Virginia Department of Health’s Division of Disease Prevention (DDP) HIV and Hepatitis Prevention and its PrEP programs.\"},{\"question\":\"How does the manual help clinicians identify patients for PrEP?\",\"answer\":\"It provides guidance for identifying indications based on substantial risk, including risk assessment in sexually active persons, individuals with bacterial STI history, condom use inconsistencies, and injection practices.\"},{\"question\":\"What does the manual cover for prescribing PrEP?\",\"answer\":\"It outlines oral daily PrEP prescribing and documentation, including managing side effects and timing to protection, and it also covers cabotegravir (CAB, Apretude) PrEP injections with initiation visits, laboratory testing, follow-up, and discontinuation or restart considerations.\"}]","Pre-Exposure Prophylaxis (PrEP) - Clinic Resource Manual - 2022 | PDF",1790538850,255]