HIV PREVENTION: UTILISATION OF ORAL HIV PRE EXPOSURE PROPHYLAXIS
Oral pre-exposure prophylaxis, or PrEP, is a way for an HIV-negative person who is at risk of HIV infection to reduce their risk of getting HIV by taking antiretroviral drugs.
How do you identify a suitable candidate for Oral PrEP use?
In accordance with the WHO Implementation Tool for Pre-exposure Prophylaxis of HIV Infection, suitable candidates for PrEP use must:
A: Meet Eligibility Criteria
B: Have no side effect with any of the HIV Treatment Drugs
7 ELIGIBILITY CRITERIA
1. Test HIV negative
2. Have no known exposure to HIV in the past 72 hrs.
3. No sign and symptoms of Acute HIV infection
4. Have no allergies or Contra-indication to PrEP medicines
5. Have creatinine clearance of >60ml/min
6. Be willing to use PrEP as prescribed and test for HIV periodically
7. Be at substantial risk of HIV infection
PEOPLE WHO ARE CONTRAINDICATED TO USE HIV PRE EXPOSURE PROPHYLAXIS
1. People who test positive for HIV
2. People who have exposure to HIV in the past 72hrs (should be on Post-exposure prophylaxis possibly)
3. People who have signs and symptoms of HIV
4. People who have allergy to PrEP drugs
5. People who have creatine clearance of lessthan 60ml/min
REGIMENT OF ORAL HIV PRE-EXPOSURE PROPHYLAXIS DRUGS
1. TDF: Tenofovir Disoproxil Fumirate
a. Single agent, can be taken orally.
b. Daily usage is 300mg per adult
c. TDF alone is safe and effective in men who have sexual intercouse with women, or women who have sexual intercourse with women.
2. TDF (Tenofocir) in combination with FTC (Emtricitabine)
a. Is safe and effective for preventing HIV in both heterosexual men amd women, and also in men who have sex with men and in transgender women.
b. The regimen contains 300mg of TDF and 200mg of FTC for adult
c. They can be contained and consumed in a single tablet called 'fixed dose combinator'.
d. Its the most commonly used PrEP in all countries
3. Tenofovir (TDF 300mg) combined eith Lamivudine (3TC 300mg)
a. TDF/FTC are considered equivalent for antiretroviral treatment.
b. There's only one study of it, but in used in some countries.
PrEP DOSING
WHO recommends 2 optiins for the dosing frequency of PrEP
A. DAILY DOSING (TAKING THE MEDICATION DAILY FOR A PRESCRIBED PERIOD OF TIME)
This is for Heterosexual men and women, and also for men who have anal intercourse with women. And it should be taken as;-
* A client should take either of the drugs for 7 days before exposing self to HIV. This ensures muximum protection.
* Daily dosage should be sustained through out the exposure period
* Those wanting to stop PrEP should continue taking the drugs for 28 days after the last HIV exposure.
2. EVENT DRIVEN (DRUG TO BE TAKEN TIMELY PRIOR TO AN EVENT YIELDING TO EXPOSURE TO HIV)
This is only for Men who have sex with Men, and :-
a. They should take a first dose of 2 PrEP pills called 'the loading dose' between 2 amd 24 hours prior to exposure/intercourse.
b. They should take the second dose of single pill after 24htɗrs of the exposure
c. Third dose is a single dose, and to be taken after 24hrs of the secomd dose.
SUGGESTED CLINICAL PROCEDURE SCHEDULE
Initial visit: Investigatiin amd interventions
1. Determine eligiblity for PrEP use
2. Test for Hepatitis B surface antigen
3. Test for Hepatitis C Antibody
4. Testing for STIs eg RPR test
5. Test for pregnancy (PrEP is safe during pregnancy and motherhood)
6. Review vaccination history
7. Coumsel the client on; prevention need, sexual and reproductive right, fertility interventiim, Gender base violence, substance use and mental health.
COUNSELLING ON PREP EFFECTIVENESS:
During the counselling session on HIV PrEP, the 7 key counselling messages should be clearly communicated with the client, which are;-
1. EFFICACY
PrEP is highly effective for preventing HIV.
According to CDC, PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed., and can be taken at daytime or night, with food or on empty stomach, also using alcohol or rexreational drugs doesnt ɓake PrEP less effective.
2. ADHERENCE
Adhere strcitly to dosing regiment for complete prevention
3. TIME TO PROTECTION
A. For Men and Women who have sex with women, it takes 7 days of taking PrEP pills before building complete HIV protection giant in the body.
B. For Men who have sex with Men, first dose is 2 pills, followed by second single pill after 24 hours of the exposure, and also another single dose after 24hrs of taking the second dose.
REDUCING STIGMA FOR HIV PrEP
Educate the community to help them umderstand the diffrence between HIV treatment and PrEP. Also, guide the community members to understand that PrEP should be viewed as a responsible choice to protect health
