Quick Clinical Guide - HIV PrEP Pre-Exposure Prophylaxis - AETC AIDS Education & Training Center CDPH Pacific

Sep 27, 2026

Uploaded by lilac

Quick Clinical Guide: HIV PrEP (Pre-Exposure Prophylaxis) provides concise clinical steps for evaluating candidates, discussing expectations, and conducting safety screening. It outlines when to offer PrEP to HIV-negative individuals with ongoing risk, how to counsel on adherence, timing of protection by exposure site, and managing resistance concerns through timely HIV testing. The guide also specifies baseline testing requirements, including HIV testing strategy, renal function thresholds, hepatitis B and C considerations, and regular STI monitoring for patients on PrEP.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Identify patients who may benefit from PrEP

Discuss PrEP with your patient

Take a medical, sexual, substance use history and review of symptoms

Obtain baseline testing

Quick Clinical Guide:HIV PrEPPre-Exposure Prophylaxis AETC AIDS Education & Training Center CDPH Pacific Pre-exposure prophylaxis(PrEP)is safe and effective for significantly reducing the risk of HIV infection in sexually active individualsand people who inject drugs(PWID).The U.S.Preventive Services Task Force has given PrEP Grade A status.This document is abrief "how-to guide,"including medication coverage options and links to patient assistance programs for low-income patients.Forresources and referrals,go to PleasePrEPMe.org.All web links are clickable in this document. # 1.Identify patients who may benefit from PrEP: ·HIV-negative individuals,including adolescents,menwho have sex with men(MSM)and women,transgenderindividuals,who may benefit from PrEP include: Do NOT withhold PrEP from eligiblecandidates who: ·Are pregnant or planning to conceive ●People who ask for PrEP ·Inconsistently use condoms or other risk-reductionmethods ·People with HIV-positive partners or partners at high riskor with unknown HIV status ·Engage in substance use ·People with sexual exposures including condomlessanal sex,multiple sex partners,or transactional sex(such as sex for money,drugs,food,or housing) ·Have mental health disorders of any severity ·Experience intimate partner violence ·Have unstable housing or limited social support ·People who have been or their partners have beenincarcerated ·Have recently had an STI ·Have a partner with HIV who has an undetectableviral load ·People who inject drugs(PWID)or substances and peoplewho use stimulants,such as methamphetamine,during sex # 2.Discuss PrEP with your patient Be present and listen.Ask about interest in and readiness for PrEP: ·What do you know about PrEP?Do you know anyone on PrEP? ·What makes you want to start PrEP?What do you hope PrEP will do for you? ·What barriers do you foresee?How long do you foresee being on PrEP? Let them know what to expect and about the potential risks and benefits of PrEP.Important points include: AdherenceAdherence is correlated with higher effectiveness.Tailor adherence strategies to patient needs andlifestyle (pillbox,phone or online reminders,cell phone alarms,etc.).Many people who inject drugs arecapable of adhering to PrEP. ●For rectal exposures,detectable drug blood levels equivalent to≥4 doses/week are associated witha high level of protection. ·For vaginal/front exposures,detectable drug blood levels equivalent to 6-7 doses/week areassociated with a high level of protection.Time toTime to protection varies by site of exposure:protection·About 7 daily doses in rectal tissue.Note that there are alternatives to daily dosing that achieveprotection in rectal tissue,such as "on-demand"2-1-1 dosing(see page 3). ·About 21 daily doses in cervico-vaginal tissue,but don't let this be a barrier to prescribing PrEP. ·About 21 daily doses for blood exposures in people who inject drugs.Risk ofResistance to HIV medications can occur if acute HIV is not identified quickly while on PrEP.A negativeResistanceHIV test result should be documented within 7 days of initiating PrEP and every 3 months thereafter.Please counsel the patient to report immediately to clinic if they develop symptoms compatible withacute HIV infection (such as fever with sore throat,rash,or headache).PotentialPrEP is very well-tolerated.Nausea,abdominal discomfort,or headache is experienced in about 10%ofside effectspeople taking PrEP and usually resolves in a few weeks.Other side effects are rare (see page 3 for details). # 3.Take a medical,sexual,substance use history and review of symptoms.Check for: ·HIV exposures in the prior 72 hours;if present,offer post-exposure prophylaxis(PEP):ebgtz.org/resource/pep-guide ●Recent symptoms of a mono-like illness (fever with sore throat,rash or headache):if present,test for acute HIV(order anHIV RNA PCR viral load and an HIV 4th generation Ag/Ab test)and consider deferring PrEP until tes

FAQs

Which patients may benefit from PrEP according to the guide?

HIV-negative individuals, including adolescents and people across sexual and gender identities, may benefit if they have ongoing risk such as inconsistent condom use, condomless sex, multiple partners, transactional sex, substance use, intimate partner violence, unstable housing or limited support, recent STI, incarceration history, partners with HIV or unknown status, or injecting drugs.

What counseling points does the guide emphasize when discussing PrEP?

The guide stresses listening and assessing interest and readiness, explaining potential risks and benefits, and focusing on adherence because higher adherence correlates with greater effectiveness. It also describes protection timing by exposure site (rectal and vaginal/front) and notes appropriate alternatives to daily dosing for rectal tissue.

What baseline tests does the guide require before starting PrEP?

All patients need a negative HIV test (4th generation Ag/Ab recommended). For long-acting injectable PrEP or patients with acute HIV symptoms or possible recent exposure, the guide requires additional HIV RNA testing, plus baseline renal function assessment and hepatitis B and C status evaluation. It also calls for STI testing on a schedule while patients remain on PrEP.

Sep 27, 2026

Uploaded by lilac