Southern African PrEP Guidelines 2020
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Questions and Answers

What is the recommended frequency for monitoring renal function in individuals taking PrEP?

  • Every 3 months
  • Annually
  • Every 6 months
  • As dictated by underlying renal problems or comorbidities (correct)

    • What type of test is recommended for screening for Chlamydia trachoma and Neisseria gonococcus at PrEP initiation?

  • Culture
  • Serology
  • Microscopy
  • Nucleic acid antigen testing (correct)

    • In individuals taking PrEP, what is the recommended follow-up timeline for clinical monitoring and persistence counseling?

  • Annually
  • At 3 months, then every 6 months (correct)
  • At 3 months, then every 3 months
  • Only at the initiation of PrEP

    • Which of the following is NOT recommended for PrEP adherence?

    <p>Taking PrEP with meals (C)</p> Signup and view all the answers

    If a PrEP user experiences mild side effects, what is the recommended initial approach?

    <p>Telephone contact with a healthcare provider (D)</p> Signup and view all the answers

    What is the recommended baseline assessment for individuals initiating PrEP who are over 40 years old or have comorbidities?

    <p>Renal function (creatinine and eGFR) (A)</p> Signup and view all the answers

    What is the recommended duration of PrEP prescription at initiation?

    <p>3 months (C)</p> Signup and view all the answers

    What is the recommended approach for individuals who have identified difficulty taking PrEP pills?

    <p>Schedule a follow-up visit after 1 month (C)</p> Signup and view all the answers

    What is the recommended duration of PrEP use after the last potential exposure to HIV?

    <p>Up to 28 days (A)</p> Signup and view all the answers

    What is the primary reason why loading doses of Tenofovir disoproxil fumarate/FTC are sometimes necessary for PrEP?

    <p>To ensure sufficient tissue levels are reached quickly (C)</p> Signup and view all the answers

    Which of these groups are not specifically mentioned as benefiting from long-acting cabotegravir PrEP?

    <p>Heterosexual men (D)</p> Signup and view all the answers

    What is the name of the study investigating long-acting cabotegravir PrEP in African women?

    <p>HPTN 084 (D)</p> Signup and view all the answers

    Which of the following is NOT a recommended component of sexual health screening for individuals considering PrEP?

    <p>HIV antibody testing (B)</p> Signup and view all the answers

    What is the primary method of administration for long-acting cabotegravir PrEP?

    <p>Subcutaneous (B)</p> Signup and view all the answers

    What is the ‘2:1:1 strategy’ in the context of on-demand PrEP?

    <p>Taking two doses of PrEP before sex and one dose after (B)</p> Signup and view all the answers

    Which population group is specifically mentioned as benefiting from on-demand PrEP in the text?

    <p>Men who have sex with men (MSM) and transgender women (D)</p> Signup and view all the answers

    What is the approximate frequency of administration of long-acting cabotegravir PrEP for the HPTN 084 study?

    <p>Every two months (D)</p> Signup and view all the answers

    What is the primary concern regarding the use of on-demand PrEP?

    <p>Potential for risk disinhibition (D)</p> Signup and view all the answers

    What type of clinical trial design was employed in the HPTN 083 study on long-acting cabotegravir PrEP?

    <p>Randomized controlled trial (D)</p> Signup and view all the answers

    Compared to daily oral PrEP, what was the effectiveness of long-acting cabotegravir PrEP in the HPTN 084 study?

    <p>89% more effective (C)</p> Signup and view all the answers

    What guidance is provided for PrEP users whose risk of HIV exposure changes?

    <p>PrEP can be stopped for any reason, but should be resumed if risk increases (C)</p> Signup and view all the answers

    What is the primary reason for offering gender-affirming counselling and treatment to transgender populations in the context of PrEP?

    <p>To provide support for individuals facing stigma and discrimination (C)</p> Signup and view all the answers

    Why is the information about long-acting cabotegravir PrEP still pending approval from agencies?

    <p>The drug is not yet registered for use (A)</p> Signup and view all the answers

    What does the acronym PrEP stand for?

    <p>Pre-exposure Prevention (C)</p> Signup and view all the answers

    What is the main focus of the Partners PrEP Study mentioned in the provided content?

    <p>Assessing the effectiveness of PrEP in preventing HIV transmission among couples where one partner is HIV-positive. (D)</p> Signup and view all the answers

    According to the content, what is a key consideration regarding PrEP use in lactating women?

    <p>There is limited evidence on the safety of PrEP during breastfeeding. (A)</p> Signup and view all the answers

    Which research paper focuses on the prevalence and correlates of STIs in pregnant women in South Africa?

    <p>Joseph Davey DL, Nyemba DC, Gomba Y, et al.Prevalence and correlates of sexually transmitted infections in pregnancy in HIV-infected and- uninfected women in Cape Town, South Africa.PLoS One. 2019;14(7):e0218349.https://doi.org/10.1371/journal.pone.0218349 (B)</p> Signup and view all the answers

    What is the primary concern regarding PrEP usage and risk behavior?

    <p>PrEP use may lead to increased risk-taking behavior, potentially offsetting the benefits of PrEP. (B)</p> Signup and view all the answers

    Which source provides data and information on the global HIV/AIDS epidemic?

    <p>UNAIDS (A)</p> Signup and view all the answers

    Which research paper specifically investigates the impact of PrEP on risk behavior among men who have sex with men?

    <p>Freeborn K, Portillo CJ.Does pre-exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour?A systematic review.J Clin Nurs. 2018;27(17–18):3254–3265.https://doi.org/10.1111/jocn.13990 (A)</p> Signup and view all the answers

    Which source specifically provides a snapshot of PrEP scale-up, registration, and resources in South Africa?

    <p>AIDS Vaccine Advocacy Coalition (C)</p> Signup and view all the answers

    What is the primary purpose of pre-exposure prophylaxis (PrEP)?

    <p>To prevent the acquisition of HIV (A)</p> Signup and view all the answers

    Which group has been newly included in the eligible demographics for PrEP as per the updated 2020 guidelines?

    <p>Pregnant and breastfeeding women (A)</p> Signup and view all the answers

    What significant change regarding PrEP delivery was introduced in the 2020 guidelines?

    <p>Introduction of on-demand PrEP for certain populations (C)</p> Signup and view all the answers

    What is one of the main barriers to PrEP use identified in the guidelines?

    <p>Clinical and health system barriers to initiation (D)</p> Signup and view all the answers

    According to the guidelines, PrEP should be offered to individuals exposed to HIV through which of the following means?

    <p>Sexual transmission and other means (A)</p> Signup and view all the answers

    What is a suggested method to measure the success of PrEP rollout according to the updated guidelines?

    <p>Parameters specifically outlined in the guidelines (C)</p> Signup and view all the answers

    What has been noted as the status of PrEP use in the South African population?

    <p>Unacceptably low and insufficient for impact (C)</p> Signup and view all the answers

    Which of the following is a recommended aspect of clinical practice related to PrEP administration?

    <p>Implementation of same-day PrEP initiation (D)</p> Signup and view all the answers

    What is the primary focus of the research referenced in the provided text?

    <p>Investigating the effectiveness and acceptability of various HIV prevention strategies for couples where one partner is HIV-positive and the other is HIV-negative. (D)</p> Signup and view all the answers

    Which of the following research studies is NOT cited in the provided text?

    <p>The impact of HIV treatment adherence on viral suppression in serodiscordant couples. (C)</p> Signup and view all the answers

    Which of the following is CORRECT regarding the research on PrEP for HIV prevention in serodiscordant couples?

    <p>The research suggests that PrEP can be a valuable tool for HIV prevention in serodiscordant couples, offering high levels of effectiveness. (A)</p> Signup and view all the answers

    What is the main implication of the research on safer conception services for HIV-affected couples?

    <p>Safer conception services are a feasible and valuable approach to HIV prevention in serodiscordant couples. (A)</p> Signup and view all the answers

    What does the term “serodiscordant” refer to in the context of the research highlighted in the provided text?

    <p>Couples where one partner is HIV-positive and the other is HIV-negative. (C)</p> Signup and view all the answers

    Based on the research cited, what is the primary goal of safer conception services for HIV-affected couples?

    <p>To prevent HIV transmission from the HIV-positive partner to the HIV-negative partner during conception. (B)</p> Signup and view all the answers

    Study Notes

    Southern African Guidelines on PrEP: 2020

    • PrEP (pre-exposure prophylaxis) with antiretroviral agents is a standard HIV prevention method
    • Oral PrEP is safe and effective for preventing HIV transmission through sexual or other means
    • PrEP use in Southern Africa is currently low and needs improvement
    • Updated 2020 guidelines aim for broader PrEP access
    • Eligibility expanded to include pregnant and breastfeeding women
    • Streamlined PrEP initiation and administration (same-day PrEP)
    • On-demand PrEP now included for MSM and TG women
    • Updated adverse event and drug interaction information
    • Parameters to measure PrEP rollout effectiveness are suggested

    Background

    • First Southern African HIV Clinicians Society guidelines published in 2012
    • Guidelines based on three clinical trials: iPrEx, Partners PrEP, and TDF2
    • Since 2012, further trials and studies confirmed the efficacy of combination therapies (e.g., tenofovir and emtricitabine) for HIV prevention
    • WHO target of 3 million PrEP users worldwide by 2020
    • South Africa faces high HIV incidence (15% of global new infections) despite estimated 45,000 people on PrEP in June 2020

    Quick Facts on Oral PrEP

    • PrEP involves daily use of TDF or TAF/FTC, TDF/FTC co-formulated or variants
    • Most used and licensed for oral PrEP is TDF/FTC
    • PrEP is shown to effectively prevent HIV transmission from heterosexual and drug use relationships
    • Consistent PrEP adherence yields over 95% protection
    • Daily use ensures optimal efficacy
    • Condoms are still recommended for STI prevention
    • PrEP has no contraceptive effect
    • PrEP is safe during pregnancy and breastfeeding

    When PrEP Should Not Be Offered

    • Confirmed or suspected HIV-positive individuals
    • HIV seroconversion is suboptimal time for PrEP implementation
    • Acute viral illness individuals (suspect HIV seroconversion)
    • Pre-existing significant renal dysfunction (eGFR <50 mL/min)
    • Individuals with significant weight (<35 kg)

    Simplifying PrEP Use

    • Ensure PrEP users understand the intervention and have a personal plan
    • PrEP users must be HIV-negative (rapid test acceptable)
    • The PrEP suitability and safety is assessed before initiating the treatment, including renal function evaluation and assessing other possible contraindications
    • Step-by-step clinical consultations with PrEP users
    • STI screening recommended at initiation, and 6-monthly for key populations
    • Hepatitis B screening and vaccination, if indicated or status unknown
    • Renal function baseline screening (creatinine and eGFR) for patients over 40 or with co-morbidities

    Considerations for Pre-Exposure Prophylaxis

    • On-demand PrEP is offered to MSM and TG women in two pills before potential sex, with another pill followed for two days after the encounter
    • The frequency of PrEP dosing varies based on potential exposure risk, vaginal or anal mucosa, and if HIV exposure is occurring.
    • If PrEP user's risk level changes, continuation or cessation is recommended, guided by potential exposure risks
    • PrEP use should be offered as part of a comprehensive package focused on STI prevention, contraception, and general sexual and reproductive health, with explicit consent

    Updates to Adverse Events and Drug-Drug Interactions

    • TDF/TAF are generally safe and well-tolerated
    • Minor side effects (headache/GI upset) are common in 10% of patients and resolve naturally
    • Some degree of renal reduction in CrCl might occur in the first few months of initiating
    • Renal function monitoring is recommended for PrEP users, especially pregnant women, aged >40 or with underlying conditions.
    • Tenofovir-based PrEP needs to be taken with caution in individuals with pre-existing renal issues, since it can impact renal function.
    • For patients with reduced bone mass or other relevant risk factors, TAF or episodic TDF is suggested as an alternative
    • Hepatitis B screening is recommended before initiating PrEP but does not prevent it.
    • Drug interactions are manageable; Tenofovir (TDF) needs to be used with caution for drugs causing renal toxicity

    Conclusion

    • PrEP guidelines will be adapted with ongoing research and clinical trials
    • Wider PrEP uptake (in different modalities) is critical for HIV preventative efforts

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    Related Documents

    2020 Southern African HIV PrEP Guidelines PDF

    Description

    Explore the updated 2020 guidelines for pre-exposure prophylaxis (PrEP) in Southern Africa. This quiz covers essential information about PrEP's efficacy, safety, eligibility criteria, and the need for improved access to prevention methods. Test your knowledge on the latest recommendations and studies informing these guidelines.

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