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HIV PrEP Overview for Clinicians

What is PrEP

PrEP stands for Pre-exposure Prophylaxis. It is the use of daily (or on demand) oral antiretroviral therapy (ART) by HIV negative individuals to reduce the risk of acquiring HIV. PrEP refers to ongoing use of ART before and after potential exposure to HIV. This is different from post-exposure prophylaxis (PEP), where a short course of ART is used immediately after a high-risk exposure event.

How does PrEP work?

PrEP is the medication Tenofovir disoproxil fumarate/emtricitabine 300/200 mg (eg.TDF/FTC, Truvada). It works by blocking an enzyme called HIV reverse transcriptase. When it blocks this enzyme, it prevents HIV from making more copies of itself in the body.

Who is PrEP for?

PrEP is for anyone who is at higher risk of HIV infection. A person must be HIV negative to be on PrEP. 

PrEP initiation and/or further assessment is recommended for:

1.  Cis- and Transgender Men who have Sex with Men (MSM) and Transgender Women (TGW) who have condomless anal sex and any of the following:

  • Infection syphilis or rectal bacterial sexually transmitted infection (STI), particularly if diagnosed in the preceding 12 months.
  • Use of non-occupational post-exposure prophylaxis (nPEP) on more than one occasion.
  • Ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200copies/ml.
  • HIV Incidence Risk Index for men who have sex with men (HIRI-MSM) score ≥10. A HIRI score can be completed based on previous, current or potential future sexual and drug use practices.

2.  Persons who Inject Drugs (PWID) that report sharing injection equipment and that have an HIV-positive injecting partner who is not receiving stable ART and/or does not have an HIV viral load <200 copies/ml.

3. Other persons who do not fit into the above criteria, including:

  • Those who report condomless vaginal or anal sex and have an ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200copies/ml.
  • Other populations clinically assessed to be at high risk for HIV infection including: unprotected vaginal/anal sex with partners from MSM/PWID population of unknown HIV status, transgender men, gender diverse individuals, or people engaging in sex work.
  • Client self-referral: clients who self-refer for PrEP may be an indication of undisclosed risk and merits further assessment.

If your client does not meet these eligibility criteria for provincially-funded PrEP, you should:

  • Encourage your client to continue with STI and HIV screening and testing as needed.
  • Encourage the use of condoms and other harm reduction strategies such as supporting knowledge around sexual health and healthy relationships, linking clients to mental health and other self-care programs or resources as needed, and use of clean needles or other drug supplies. Some information can be found on the CATIE or the Sex and U websites.
  • Review your client’s PrEP eligibility and HIRI score (if relevant) on an ongoing basis, as circumstances change over time.

It is important to remember that PrEP is part of a suite of sexual health interventions.  It is not just about the drug.

Prescribing PrEP

Who can prescribe PrEP?

Any doctor that is licensed to practice in BC can prescribe PrEP. Nurse practitioners who have taken the Treatment for HIV Prevention program at the BC Centre for Excellence in HIV/AIDS (BC CfE) can also prescribe PrEP. 

If you are a primary care physician or nurse practitioner and you are willing to prescribe PrEP, or you are a registered nurse conducting PrEP assessments, please refer to our PrEP Resources page for all the relevant resources.

If you are not comfortable with assessing clients and prescribing PrEP, please refer your client to another provider who is willing to prescribe PrEP.  Public health STI clinics and primary care centres are good options. You can complete the Prescriber Notification Letter for your client to bring with them.

How much does PrEP cost?

Provincially-funded PrEP is available through the HIV Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS.

To be eligible for free PrEP, a person needs to be:

  • HIV-negative
  • At substantial risk for HIV infection
  • A current BC resident with Medical Services Plan (MSP) coverage or Interim Federal Health coverage (e.g. Refugee status)

People living in BC without MSP or Interim Federal Health coverage can still get PrEP, though it will not be provincially-funded. To access PrEP, individuals will need to either:

  • Pay for it themselves
  • Seek coverage through a private insurer or extended health care
  • Purchase it through the Davie Buyers Club

Inuit persons living in BC can access free PrEP through the Non-Insured Health Benefits (NIHB) program; pre-approval from the BC CfE is not required. First Nations and Metis people living in BC can only access free PrEP through the HIV Drug Treatment Program at the BC CfE.

What next?

Starting PrEP

A first-time PrEP prescription is limited to a 30-44 day supply.

If your client intends to continue on PrEP for a longer term, a clinic visit with STI, HIV and kidney testing (Creatinine and urinalysis or Urine albumin to creatinine ratio) is required before the prescription can be renewed. A maximum of 90 days will be supplied for ongoing PrEP prescriptions.

Once on PrEP, your client will need to be monitored regularly.

To make follow-up testing easier, clients can sign-up to receive PrEP testing reminders by email or text.

Where is PrEP picked up?

HIV PrEP medication must be picked up within 30 days of the authorized prescription date.

  • In Vancouver and the Greater Vancouver area: PrEP can be picked up at St. Paul’s Hospital Ambulatory Pharmacy.
  • Outside of the Greater Vancouver area: PrEP can be delivered to the prescriber's office, a Health Unit, pharmacy, or other location in collaboration with the prescriber and the BC CfE.

For more information

Download or print our What you need to know about HIV PrEP information sheet for health care providers or share our FAQs about HIV PrEP with your clients (also available Spanish, Simplified Chinese or Punjabi).

Resources

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