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

Flashcards

Pre-Exposure Prophylaxis (PrEP)

A medication taken regularly by people who are at risk of HIV infection to prevent them from becoming HIV positive.

Renal function assessment

A test to check kidney function by measuring the amount of creatinine in the blood and calculating the estimated glomerular filtration rate (eGFR).

PrEP medication

A medication taken regularly to prevent HIV infection, given to people who are at high risk of acquiring HIV. The medication is typically taken daily.

Underlying renal problem

A condition that can affect the kidneys, often caused by high blood pressure or diabetes.

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PrEP users

People who are at risk of acquiring HIV infection.

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Pill-taking

The act of taking a medication as prescribed by a doctor.

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Pill-taking support

Strategies to help people remember to take their medications regularly.

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Syndromic STI screening

A set of symptoms that suggest a particular disease, such as a sexually transmitted infection.

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HIV prevention package

A key part of a strategy to prevent HIV infection, along with other measures like condoms and testing.

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HIV incidence

The rate at which new HIV infections occur in a population.

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Accessibility

Making something easier to get and use, such as PrEP.

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On-demand PrEP

A type of PrEP where the medication is taken only when needed, often before sexual activity.

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Adverse events and drug-drug interactions

Problems that can occur when taking PrEP, like side effects or interactions with other medications.

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Parameters for measuring PrEP rollout and success

Factors used to evaluate how well PrEP rollout is going and how successful it is.

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HIV control measure

A comprehensive strategy for controlling the spread of HIV, with a focus on reducing new infections and improving health outcomes.

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What is PrEP?

Taking a medicine before possible exposure to HIV to lower risk of infection.

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How does PrEP work?

PrEP can only prevent HIV if it is in the body at sufficient levels when exposed.

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Does PrEP need to be taken before every exposure?

The length of time PrEP needs to be taken before exposure varies based on which body part is exposed and the type of exposure.

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Stopping PrEP.

If someone stops PrEP, they should be advised to continue taking it for 28 days after last potential exposure. However, this recommendation is based on models, not confirmed by clinical research.

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Is PrEP permanent?

PrEP is not a lifetime intervention and can be stopped.

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Can PrEP be taken on demand?

PrEP can be taken on demand, or before specific sexual encounters, instead of daily.

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How to take On-Demand PrEP?

On-demand PrEP for sexually active individuals involves a specific dosage: Two pills taken 2-24 hours before sex, followed by one pill daily for the next two days.

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What is risk disinhibition?

There is a possibility that PrEP might lead to an increase in risky behavior because individuals feel more confident about being protected. However, PrEP is highly effective, and the risk of HIV infection is still very low, even with increased risky behavior.

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HIV-serodiscordant couple

A couple where one partner is HIV-positive and the other is HIV-negative.

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Safer conception strategies

Methods used to prevent HIV transmission during conception, for example using sperm washing or in-vitro fertilization.

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Qualitative study

A qualitative research method where participants are asked open-ended questions to explore their opinions and experiences.

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Efficacy

The effectiveness of a treatment or intervention in preventing the occurrence of a new disease or condition.

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PrEP

A medication taken regularly by someone who is at risk of getting HIV to prevent them from becoming infected.

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PrEP use in MSM

The use of PrEP among people who have sex with men.

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PrEP accessibility

The process of making something easier to get and use, like PrEP.

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Randomized, placebo-controlled PrEP studies

Studies where participants are randomly assigned to different groups, one receiving the treatment being studied (PrEP) and the other receiving a placebo.

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Longitudinal study

A study design that follows participants over time and collects data on their health and behaviors.

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Cohort study

A study design that compares two groups of people, one that has been exposed to something (like PrEP) and one that hasn't.

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PrEP study analysis

The analysis of data from studies on PrEP use to understand its effectiveness and safety.

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Long-acting cabotegravir PrEP

A type of pre-exposure prophylaxis (PrEP) that involves injecting a long-acting medication (cabotegravir) every two months to prevent HIV infection.

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HPTN 083

A clinical trial that investigated the effectiveness of long-acting cabotegravir PrEP compared to daily oral PrEP in men who have sex with men (MSM) and transgender women.

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HPTN 084

A clinical trial that evaluated the effectiveness of long-acting cabotegravir PrEP in women, with results showing that it was significantly more effective than daily oral PrEP.

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IPERGAY

A study investigating the effectiveness of on-demand PrEP for men who have sex with men and transgender women.

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Oral PrEP

A medication taken daily to prevent HIV infection.

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Long-acting PrEP

A type of PrEP that involves injecting a medication that lasts for a longer period, like 2 months.

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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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