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Introduction
Pre-exposure prophylaxis
Pre-exposure prophylaxis (PrEP) involves taking a pharmaceutical agent prior to an exposure to prevent an outcome (e.g. infection by a microbe, such as malaria). PrEP for HIV involves the use of antiretroviral (ARV) medications to prevent HIV infection. Research into the use of existing and novel PrEP agents, as well as various delivery systems, including topical gels and rings (microbicide) and oral (tablet) and long-acting injectable formulations, is ongoing.
Tenofovir (TDF) and tenofovir/emtricitabine (TDF/FTC) in a single tablet fixed-dose combination (FDC) are the oral ARV agents used in oral PrEP studies to date. The present guidelines support the use of TDF/FTC in combination for effective PrEP. TDF-containing PrEP is recommended by the World Health Organization (WHO) for people at substantial risk of HIV infection.1 In December 2015, the TDF/FTC combination pill was approved for use as PrEP by the Medicine Control Council, in combination with safer sexual practices.2
The aim of the this PrEP guideline is to:
* explain what PrEP is
* outline current indications for its use
* outline steps for appropriate user selection
* provide guidance to monitor and maintain PrEP users.
PrEP is indicated for HIV-negative men who have sex with men (MSM), transgender persons, heterosexual men and women (including adolescents) and people who inject drugs (PWID), who are assessed to be at high risk for HIV acquisition. PrEP should be used as part of a package of HIV prevention services (which may include regular HIV testing, condoms, lubrication, contraception, sexually transmitted infection [STI] management and risk reduction counselling). PrEP is also applicable to individuals at risk of HIV acquisition because they are unwilling or unable to consistently use male or female condoms, especially if in serodiscordant relationships. The user must be counselled on ongoing pregnancy and STI risk. PrEP can also be effective as part of a broader prevention package for people who use and inject drugs (PWID) in the comprehensive setting of needle and syringe exchange and opioid substitution programmes and access to ART for injecting networks. Harm reduction is an extensively proven HIV prevention intervention for PWID, but is not discussed further in these guidelines.
Recommendations
Daily PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and...