This content is part of a paid partnership with WAAC.
What is PrEP?
Coformulated tenofovir and emtricitabine (TDF/FTC) has been proven to be effective as pre-exposure prophylaxis (PrEP) for HIV. When taken as prescribed, PrEP can reduce the risk of sexually transmitted HIV by up to 99%.
Who can prescribe PrEP?
PrEP is listed on the Pharmaceutical Benefits Scheme as an s85 medication. This allows any medical practitioner or endorsed nurse practitioner to prescribe PrEP to eligible clients. According to data from the Pharmaceutical Benefits Scheme, 47,172 Australians were dispensed PrEP in the April-June quarter of 2024.
What are the barriers to PrEP prescription?
Research suggests that there are still gaps in Australian health professionals’ PrEP knowledge and confidence. For instance, a qualitative study of health professionals found that barriers to PrEP prescription included lack of familiarity with the clinical guidelines, a perceived lack of patient demand, and a perception that PrEP is a specialist medicine.
Similarly, an online cross-sectional survey of 407 GPs found that less than half felt confident prescribing PrEP, with the main barriers being ‘difficulty identifying clients who require PrEP/relying on clients to ask for PrEP’ (76%, 310/407) and ‘lack of knowledge about PrEP’ (70%, 286/407).
Who should be considered for PrEP?
Anyone at risk of HIV acquisition should be considered for PrEP.
Indicators of behavioural suitability include:
- Casual receptive condomless intercourse with any men who have sex with other men (MSM).
- Rectal or vaginal gonorrhoea, chlamydia or infectious syphilis in a person who is not exclusively heterosexual.
- Methamphetamine use.
- Condomless intercourse with a regular HIV+ partner who is not on treatment and/or has a detectable viral load.
- A person in a HIV serodiscordant heterosexual relationship who is planning natural conception in the next 3 months.
- Shared injecting equipment with an HIV+ individual or with MSM of unknown HIV status.
Low rates of PrEP use have been reported among overseas-born gay/bisexual MSM and gay/bisexual MSM who consider themselves to be at low risk of HIV acquisition because they are in mostly monogamous relationships. It is important to ensure that these groups are considered for PrEP suitability to avoid the emergence of HIV disparities.
What support is available for health professionals interested in prescribing PrEP?
- ASHM (previously the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) has published PrEP Guidelines to assist health professionals. These are available at prepguidelines.com.au. The guidelines are accompanied by a two-page, step-by-step decision-making tool for clinicians (scan the QR code on the accompanying page).
- ASHM also offers a free 40-60 minute introduction to PrEP prescribing online learning module: ashm.org.au/lms/introduction-to-prep-prescribing/
- While all medical practitioners and endorsed nurse practitioners can prescribe PrEP, you can refer your patients to another health professional if you feel you are not yet ready. WA Health maintains a list of ‘PreP confident’ prescribers here: https://www.health.wa.gov.au/Articles/N_R/PrEP-Prescribers (or scan the QR code on the accompanying page).
- If your patients want to know more about PrEP, you can refer them to www.waac.com.au/prep/
Sponsored by WAAC with support from the WA Department of Health
