Prioritize key moments to begin the PrEP conversation
Finding the right time to discuss PrEP means you can help make it a positive experience
Common opportunities to have a productive discussion about PrEP:
Annual checkups and episodic care
Your conversation could be the only time someone is informed about PrEP:
of individuals visit a physician
of individuals visit a physician less than once a year, rarely, or never1
STI visits
STIs can increase an individual’s likelihood of acquiring HIV:
of individuals who were recently diagnosed with HIV had an
of individuals who were recently diagnosed with HIV had an STI in the last 6 months2STI in the last 6 months2
(Truong HM, 2015; N=214. Study analyzed cases between 2005 and 2011 at publicly funded and community-based clinics in San Francisco)
A PrEP discussion during an STI diagnosis
increased the odds of initiating PrEP by 97x3
(Kobayashi T, 2021; N=270. Retrospective cohort and nested case control study used data from 2013-2018)
Any time DoxyPEP is offered for bacterial STI prevention
Several guidelines recommend linking individuals on DoxyPEP to HIV PrEP,
including the CDC and NYSDOH AI4-6
Any time nPEP is requested
HIV acquisition has been reported in association with exposures soon after completing an nPEP course7
Daily PrEP may be more protective than repeated intermittent regimens of nPEP7
Visits with anyone who has previously been on PrEP and is HIV negative
Discontinuing PrEP increased the likelihood of acquiring HIV8
(Tao L, 2023; 522,273 prescriptions of PrEP were analyzed between January 2019 and February 2023, selected from IQVIA® LAAD. Observational study compared delays of PrEP dispensation from day 0, when PrEP was dispensed.)
Individuals who stopped using PrEP saw a
increase in HIV diagnoses
compared to those who continued using PrEP9
(Spinelli MA, 2020; N=986. Observational study analyzed patient cases from 2012-2018 in San Francisco, CA)
CDC=Centers for Disease Control and Prevention; IQVIA LAAD=IMS Health, Quintiles, and VIA Longitudinal Access and Adjudication Data; nPEP=nonoccupational postexposure prophylaxis; NYSDOH AI=New York State Department of Health AIDS Institute; STI=sexually transmitted infection.
Additional common factors to help you identify those who may be appropriate for PrEP4:
- A recent history of STIs
- One or more sexual partners who don’t know their HIV status
- A person who doesn’t always use condoms when having sex
- A partner living with HIV
- Having sex in a geographic area or sexual network where HIV is prevalent
References:
1. Data on file. Gilead Sciences, Inc.
2. Truong HM, Pipkin S, O'Keefe KJ, et al. Brief report: Recent infection, sexually transmitted infections and transmission clusters frequently observed among persons newly-diagnosed with HIV in San Francisco. J Acquir Immune Defic Syndr. 2015;69(5):606-609.
3. Kobayashi T, Van Epps P, Maier M, et al. Discussion and initiation of HIV pre-exposure prophylaxis were rare following diagnoses of sexually transmitted infections among veterans [abstract taken from J Gen Intern Med. 2022;37(10):2482-2488]. Open Forum Infect Dis. 2021;8(suppl 1):519S-520S.
4. Bachmann LH, Barbee LA, Chan P, et al. CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024. MMWR Recomm Rep. 2024;73(2):1-8.
5. Quinn C, Pathela P. Doxycycline post-exposure prophylaxis (Doxy-PEP) to prevent bacterial sexually transmitted infections. New York City Department of Health and Mental Hygiene. Published November 9, 2023. https://www.nyc.gov/assets/doh/downloads/pdf/std/dear-colleague-doxy-PEP-to-prevent-bacterial-STI-11092023.pdf
6. DiMarco DE, Urban MA; Medical Care Criteria Committee. Doxycycline post-exposure prophylaxis to prevent bacterial sexually transmitted infections. National Institutes of Health. Published September 25, 2023. Accessed September 12, 2024. https://www.ncbi.nlm.nih.gov/books/NBK597440/
7. Centers for Disease Control and Prevention. US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 Update: a clinical practice guideline. Accessed September 12, 2024. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
8. Tao L, Yang J, Zachry W, Gruber J, Mezzio D. The real-world impact of pre-exposure prophylaxis (PrEP) prescription uptake and dispensing status on HIV infection risk in the US. Poster presented at: IDWeek 2023; October 11-15, 2023; Boston, MA. Poster 1557.
9. Spinelli MA, Laborde N, Kinley P, et al. Missed opportunities to prevent HIV infections among pre-exposure prophylaxis users: a population-based mixed methods study, San Francisco, United States. J Int AIDS Soc. 2020;23(4):e25472.