Podcast
Questions and Answers
What is the recommended frequency for monitoring renal function in individuals taking PrEP?
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?
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?
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?
Which of the following is NOT recommended for PrEP adherence?
If a PrEP user experiences mild side effects, what is the recommended initial approach?
If a PrEP user experiences mild side effects, what is the recommended initial approach?
What is the recommended baseline assessment for individuals initiating PrEP who are over 40 years old or have comorbidities?
What is the recommended baseline assessment for individuals initiating PrEP who are over 40 years old or have comorbidities?
What is the recommended duration of PrEP prescription at initiation?
What is the recommended duration of PrEP prescription at initiation?
What is the recommended approach for individuals who have identified difficulty taking PrEP pills?
What is the recommended approach for individuals who have identified difficulty taking PrEP pills?
What is the recommended duration of PrEP use after the last potential exposure to HIV?
What is the recommended duration of PrEP use after the last potential exposure to HIV?
What is the primary reason why loading doses of Tenofovir disoproxil fumarate/FTC are sometimes necessary for PrEP?
What is the primary reason why loading doses of Tenofovir disoproxil fumarate/FTC are sometimes necessary for PrEP?
Which of these groups are not specifically mentioned as benefiting from long-acting cabotegravir PrEP?
Which of these groups are not specifically mentioned as benefiting from long-acting cabotegravir PrEP?
What is the name of the study investigating long-acting cabotegravir PrEP in African women?
What is the name of the study investigating long-acting cabotegravir PrEP in African women?
Which of the following is NOT a recommended component of sexual health screening for individuals considering PrEP?
Which of the following is NOT a recommended component of sexual health screening for individuals considering PrEP?
What is the primary method of administration for long-acting cabotegravir PrEP?
What is the primary method of administration for long-acting cabotegravir PrEP?
What is the ‘2:1:1 strategy’ in the context of on-demand PrEP?
What is the ‘2:1:1 strategy’ in the context of on-demand PrEP?
Which population group is specifically mentioned as benefiting from on-demand PrEP in the text?
Which population group is specifically mentioned as benefiting from on-demand PrEP in the text?
What is the approximate frequency of administration of long-acting cabotegravir PrEP for the HPTN 084 study?
What is the approximate frequency of administration of long-acting cabotegravir PrEP for the HPTN 084 study?
What is the primary concern regarding the use of on-demand PrEP?
What is the primary concern regarding the use of on-demand PrEP?
What type of clinical trial design was employed in the HPTN 083 study on long-acting cabotegravir PrEP?
What type of clinical trial design was employed in the HPTN 083 study on long-acting cabotegravir PrEP?
Compared to daily oral PrEP, what was the effectiveness of long-acting cabotegravir PrEP in the HPTN 084 study?
Compared to daily oral PrEP, what was the effectiveness of long-acting cabotegravir PrEP in the HPTN 084 study?
What guidance is provided for PrEP users whose risk of HIV exposure changes?
What guidance is provided for PrEP users whose risk of HIV exposure changes?
What is the primary reason for offering gender-affirming counselling and treatment to transgender populations in the context of PrEP?
What is the primary reason for offering gender-affirming counselling and treatment to transgender populations in the context of PrEP?
Why is the information about long-acting cabotegravir PrEP still pending approval from agencies?
Why is the information about long-acting cabotegravir PrEP still pending approval from agencies?
What does the acronym PrEP stand for?
What does the acronym PrEP stand for?
What is the main focus of the Partners PrEP Study mentioned in the provided content?
What is the main focus of the Partners PrEP Study mentioned in the provided content?
According to the content, what is a key consideration regarding PrEP use in lactating women?
According to the content, what is a key consideration regarding PrEP use in lactating women?
Which research paper focuses on the prevalence and correlates of STIs in pregnant women in South Africa?
Which research paper focuses on the prevalence and correlates of STIs in pregnant women in South Africa?
What is the primary concern regarding PrEP usage and risk behavior?
What is the primary concern regarding PrEP usage and risk behavior?
Which source provides data and information on the global HIV/AIDS epidemic?
Which source provides data and information on the global HIV/AIDS epidemic?
Which research paper specifically investigates the impact of PrEP on risk behavior among men who have sex with men?
Which research paper specifically investigates the impact of PrEP on risk behavior among men who have sex with men?
Which source specifically provides a snapshot of PrEP scale-up, registration, and resources in South Africa?
Which source specifically provides a snapshot of PrEP scale-up, registration, and resources in South Africa?
What is the primary purpose of pre-exposure prophylaxis (PrEP)?
What is the primary purpose of pre-exposure prophylaxis (PrEP)?
Which group has been newly included in the eligible demographics for PrEP as per the updated 2020 guidelines?
Which group has been newly included in the eligible demographics for PrEP as per the updated 2020 guidelines?
What significant change regarding PrEP delivery was introduced in the 2020 guidelines?
What significant change regarding PrEP delivery was introduced in the 2020 guidelines?
What is one of the main barriers to PrEP use identified in the guidelines?
What is one of the main barriers to PrEP use identified in the guidelines?
According to the guidelines, PrEP should be offered to individuals exposed to HIV through which of the following means?
According to the guidelines, PrEP should be offered to individuals exposed to HIV through which of the following means?
What is a suggested method to measure the success of PrEP rollout according to the updated guidelines?
What is a suggested method to measure the success of PrEP rollout according to the updated guidelines?
What has been noted as the status of PrEP use in the South African population?
What has been noted as the status of PrEP use in the South African population?
Which of the following is a recommended aspect of clinical practice related to PrEP administration?
Which of the following is a recommended aspect of clinical practice related to PrEP administration?
What is the primary focus of the research referenced in the provided text?
What is the primary focus of the research referenced in the provided text?
Which of the following research studies is NOT cited in the provided text?
Which of the following research studies is NOT cited in the provided text?
Which of the following is CORRECT regarding the research on PrEP for HIV prevention in serodiscordant couples?
Which of the following is CORRECT regarding the research on PrEP for HIV prevention in serodiscordant couples?
What is the main implication of the research on safer conception services for HIV-affected couples?
What is the main implication of the research on safer conception services for HIV-affected couples?
What does the term “serodiscordant” refer to in the context of the research highlighted in the provided text?
What does the term “serodiscordant” refer to in the context of the research highlighted in the provided text?
Based on the research cited, what is the primary goal of safer conception services for HIV-affected couples?
Based on the research cited, what is the primary goal of safer conception services for HIV-affected couples?
Flashcards
Pre-Exposure Prophylaxis (PrEP)
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
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
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
Underlying renal problem
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PrEP users
PrEP users
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Pill-taking
Pill-taking
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Pill-taking support
Pill-taking support
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Syndromic STI screening
Syndromic STI screening
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HIV prevention package
HIV prevention package
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HIV incidence
HIV incidence
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Accessibility
Accessibility
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On-demand PrEP
On-demand PrEP
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Adverse events and drug-drug interactions
Adverse events and drug-drug interactions
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Parameters for measuring PrEP rollout and success
Parameters for measuring PrEP rollout and success
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HIV control measure
HIV control measure
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What is PrEP?
What is PrEP?
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How does PrEP work?
How does PrEP work?
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Does PrEP need to be taken before every exposure?
Does PrEP need to be taken before every exposure?
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Stopping PrEP.
Stopping PrEP.
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Is PrEP permanent?
Is PrEP permanent?
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Can PrEP be taken on demand?
Can PrEP be taken on demand?
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How to take On-Demand PrEP?
How to take On-Demand PrEP?
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What is risk disinhibition?
What is risk disinhibition?
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HIV-serodiscordant couple
HIV-serodiscordant couple
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Safer conception strategies
Safer conception strategies
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Qualitative study
Qualitative study
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Efficacy
Efficacy
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PrEP
PrEP
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PrEP use in MSM
PrEP use in MSM
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PrEP accessibility
PrEP accessibility
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Randomized, placebo-controlled PrEP studies
Randomized, placebo-controlled PrEP studies
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Longitudinal study
Longitudinal study
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Cohort study
Cohort study
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PrEP study analysis
PrEP study analysis
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Long-acting cabotegravir PrEP
Long-acting cabotegravir PrEP
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HPTN 083
HPTN 083
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HPTN 084
HPTN 084
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IPERGAY
IPERGAY
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Oral PrEP
Oral PrEP
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Long-acting PrEP
Long-acting PrEP
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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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