The Commonwealth Government recently approved the listing of HIV pre-exposure prophylaxis, or PrEP, on the Pharmaceutical Benefits Scheme (PBS). From 1 April 2018 individuals at medium- to high-risk of HIV can access PrEP through the PBS to help them reduce their risk of HIV.
What is PrEP?
PrEP is the use of HIV medications to prevent the transmission of HIV. When taken daily, PrEP is up to 99 per cent effective in preventing HIV. Currently only one medication is approved for use as PrEP: tenofovir/emtricitabine. It has been used for many years to treat HIV in people living with HIV.
PrEP is one of many tools used to reduce the risk of HIV transmission, in addition to condoms and undetectable viral load (when a person living with HIV is on treatment, and is virally suppressed, they cannot transmit the virus). PrEP does not prevent other sexually transmissible infections.
What is involved in prescribing PrEP?
Before prescribing PrEP, prescribers should discuss the risk eligibility criteria with their patients. If a patient is considered eligible for PrEP, prescribers should conduct an HIV test to confirm that the patient is HIV negative. They should also test for sexually transmissible infections (STI), including gonorrhoea, chlamydia, and syphilis.
Prescriptions may be issued for 90 days of medication (a maximum dispensed quantity of 30, with two repeats). Patients should return for follow-up appointments every three months, where HIV and STI testing should be repeated. PrEP needs to be combined with regular testing for STI, timely treatment and prevention education (particularly in relation to the importance of condom use for STI prevention).
Periodic tests of bone density and renal function may also be required.
Full prescribing guidelines and recommendations can be found in the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines, known as the ASHM Guidelines. Prescribers can also review the Victorian guidance on pre-exposure prophylaxis (PrEP) for information on how to prescribe PrEP.
Who can prescribe PrEP?
PrEP has been listed as a general schedule s85 item on the PBS, and can be prescribed by both general practitioners and nurse practitioners.
Who is eligible for PrEP?
People who are considered at medium to high risk of HIV are eligible for PrEP. This includes gay men and other men who have sex with men (MSM), people who inject drugs (PWID), trans and gender diverse people, and heterosexual men and women at greater risk of HIV.
The eligibility and risk criteria are outlined in the clinical guidelines developed by the Australasian Society of HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). It is recommended that prescribers review these criteria with their patients to determine if PrEP is recommended for them. Prescribers should take a case-by-case approach and base any decision whether to recommend PrEP on the personal circumstances of the patient. The guidelines are available at the ASHM website.
Patients must hold a Medicare card in order to access PrEP through the PBS. Some people from countries that have a reciprocal health care agreement with Australia may also be eligible for PBS medications. People who are ineligible for Medicare may still receive a prescription for PrEP, but must pay full price, or import it from overseas. Patients wanting to import PrEP are encouraged to contact the Victorian AIDS Council, or the community groups PrEPaccessNOW or PrEP'd for Change for more information about personal importation.
Are there any side effects to PrEP?
Tenofovir/emtricitabine, the drug used as PrEP, has very few side effects, and very few people ever experience them. For those who do experience them, the side effects usually clear up within a few weeks of starting PrEP. Common side effects included headache, nausea, weight loss, and depression.
In a small proportion of people, tenofovir/emtricitabine may lead to a loss of bone mineral density, or a decrease in kidney function. Doctors should assess kidney function at baseline, and ask their patient about any history of osteopenia or osteoporosis before prescribing PrEP.
How much does PrEP cost?
PrEP patients are responsible for a co-payment of up to $39.50 ($6.40 concession) per 30 day supply.
People who are ineligible for subsided PrEP through the PBS must pay full price for the drug, currently up to $800 per 30 day supply. Alternately, they may access PrEP from overseas through the personal importation scheme. Costs vary from approximately $30 - $100 per 30 day supply, including delivery.
Who can I contact if I want more information?
For immediate questions about prescribing PrEP, please contact the Victorian HIV Service at Alfred Hospital on (03) 9076 6081.
Information on PrEP, including the ASHM Guidelines, are available on the ASHM website.
The Victorian guidance on pre-exposure prophylaxis (PrEP) can be found in the Downloads section on this page.
The Victorian AIDS Council provides information on PrEP designed for patients interested in taking PrEP, and can provide more information on (03) 9865 6700.