HIV pre-exposure prophylaxis information for health professionals

Pre-Exposure Prophylaxis (PrEP) medications (co-formulated tenofovir disoproxil and emtricitabine), when used with optimal adherence, are highly effective at preventing HIV transmission.

PrEP medications are registered in Australia with the Therapeutic Goods Association and listed on the Pharmaceutical Benefits Scheme (PBS) as a General Schedule item (Streamed Authority) meaning all general practitioners, other medical specialists and authorised nurse practitioners can prescribe PrEP for HIV prevention. No specialist training is required to prescribe PrEP, however, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) provide resources and training guidance for clinicians who are new to prescribing PrEP.

The ASHM 2019 PrEP Guidelines recommend daily PrEP for all people at risk of HIV infection, including men who have sex with men (MSM), heterosexual men and women, transgender people, and people who inject drugs. In addition, these guidelines also recommend that on-demand PrEP should be offered as an alternative option to cis-gender MSM.

There are three ways to access HIV PrEP in Australia:

  1. An Australian resident with a current Medicare card can access PBS subsidised PrEP at a community pharmacy with a valid prescription.

  2. Any doctor can write a private script for their patient to have dispensed at a community pharmacy. This may be an option for those without a current Medicare card who are willing to pay the private (non-PBS subsidised) cost and do not wish to use the Personal Importation Scheme.

  3. A script can be provided to any patient (including those without a current Medicare card) who can then buy the drug online from a reliable overseas supplier using the TGA’s Personal Importation Scheme. Patients can be directed to more information on personal importation at the PrEP Access Now website.

ASHM clinical guidelines

South Australian health practitioners should refer to the ASHM HIV Pre-exposure Prophylaxis Clinical Guidelines. The ASHM HIV PrEP Guidelines outline behavioural risk and suitability criteria for men who have sex with men (MSM); heterosexual men and women; trans and gender diverse people; and people who inject drugs.

In addition to assisting clinicians in assessing the suitability of patients for PrEP, the ASHM HIV PrEP Guidelines provide guidance on commencing and monitoring patients on PrEP including management of side-effects and toxicity, use of PrEP in pregnancy and in chronic hepatitis B infection; daily and on-demand (also known as event-based) PrEP dosing; and discontinuing PrEP.

The ASHM HIV PrEP Guidelines provide a recommended appointment schedule of testing and ongoing monitoring for health practitioners managing individuals accessing PrEP for HIV.

Decision making tool

A two-page Decision Making in PrEP: Prescribing Pathway for PrEP in Australia tool summarises the eligibility criteria and recommended assessment for primary care providers in Australia who wish to prescribe PrEP and as well as patient education and monitoring requirements.

Experienced clinicians and PrEP prescribers list in South Australia

To contact a clinician with experience in prescribing PrEP in South Australia, please contact the Adelaide Sexual Health Centre.

To view a list of prescribing doctors and nurse practitioners, visit the South Australian HIV Pre-Exposure Prophylaxis Prescribers List on the SHINE SA website.

Training

For information on PrEP for HIV training courses, visit the ASHM website.