This communique is for clinicians involved in HIV, who may be consulted about HIV Pre-Exposure Prophylaxis (PrEP). It assumes an understanding of HIV prophylaxis.
From 1 April 2020 Truvada® (emtricitabine/tenofovir disoproxil fumarate) for HIV treatment and for pre-exposure prophylaxis (PrEP) will no longer be available through the Pharmaceutical Benefits Scheme (PBS). This involves a decision on delisting of Truvada® taken by the Australian Minister and Department of Health under advice from the Pharmaceutical Benefits Advisory Committee (PBAC).
The ASHM Antiretroviral (ARV) Guidelines Committee recommend that patients currently receiving Truvada® can transition to other combination medicines that contain tenofovir disoproxil. These are: tenofovir disoproxil fumarate/emtricitabine (Apotex), tenofovir disoproxil maleate/emtricitabine (Mylan), and tenofovir disoproxil phosphate/emtricitabine (Tenofovir EMT GH). This recommendation is for the prevention of acquisition of HIV in pre-exposure prophylaxis (PrEP), and for the treatment of HIV in combination with other antiretrovirals as recommended by the Department of Health and Human Services (DHHS)1.
The listed alternatives are all indicated for PrEP on the PBS general schedule, and are brand equivalent. See the PBS listings here: http://www.pbs.gov.au/medicine/item/11276L-11296M-11306C
In addition, from October 2020 the Single Tablet Regimen (STR) HIV treatment Atripla® will be delisted. A generic STR of tenofovir disoproxil maleate, emtricitabine and efavirenz has been approved by the PBS and provides an option for those currently receiving Atripla®.
We strongly encourage you to inform your affected patients now of these changes to assist in their transition to an alternative therapy.
If you have any questions or require further information in the meantime, please contact: HIVPrescriber@ashm.org.au.
Co-formulated tenofovir and emtricitabine for use as HIV pre-exposure prophylaxis (PrEP) by people at risk of HIV infection is now recommended as standard care in clinical guidelines in Australia. PrEP is highly effective in preventing HIV when taken with high adherence daily or on-demand.
PrEP is an effective prevention strategy for: men who have sex with men (MSM), heterosexual men and women, transgender people, and people who inject drugs who are at-risk of HIV acquisition. In addition, on-demand PrEP is highly effective in MSM and has recently been recommended by the World Health Organisation as an option for MSM.
There are three ways to access HIV pre-exposure prophylaxis (PrEP) in Australia:
For an Australian resident with a current Medicare card, PrEP can be accessed through the Pharmaceutical Benefits Scheme (PBS) at a subsidised cost. As PrEP is listed as a Schedule 85 (s85) drug, any doctor can write a script for PrEP which can be taken to any pharmacy for dispensing. If PrEP is accessed in this way, a PBS co-payment at the pharmacy will need to be made.
Any doctor can write a private script for PrEP and they have three brands to choose from (Generic Health Pty Ltd, Apotex Pty Ltd and Alphapharm Pty Ltd). Patients can have this script dispensed at a community pharmacy. The cost for a private script is higher than for PBS-subsidised medicines. This option is generally used by people who are not eligible for Medicare and who do not feel comfortable using the Personal Importation Scheme described below.
If a person is not eligible to access PrEP through Medicare, or finds the cost of purchasing PrEP locally too high, then another option is to purchase a generic version of the drug online from a reliable overseas supplier using the Therapeutic Goods Administration’s Personal Importation Scheme. A script from a doctor is still required before ordering online. There are multiple overseas suppliers who will supply PrEP for import into Australia at a range of costs. The PrEP Access Now website has more information on personal importation.
ASHM continues to support the workforce to ensure access to PrEP and best practice in guidelines, training and resources:
To learn more about PrEP and how to prescribe you can do the PrEP Online Learning Module on ThinkGP platform.
If you are a primary care provider, you can access ASHM's latest HIV PrEP Update for Primary Care Providers webinar series by clicking HERE. You can also register to attend ASHM HIV PrEP trainings through ASHM Training page HERE.
These training sessions provide GPs, Nurses and Health Professionals working in primary care an update on strategies available for the prevention of HIV transmission, focusing on prevention particularly Pre-Exposure Prophylaxis (PrEP).
ASHM hosted a Facebook Live Q+A: PREPPING the Health Workforce on 12 April 2018 with an expert clinical and community panel.
This new 2-page Decision Making in PrEP tool provides a prescribing pathway which summarises the key eligibility and recommended assessment for primary care providers in Australia who wish to prescribe PrEP and the ongoing patient education and monitoring requirements.
Find links to further information:
From 1 October 2019 the criteria for prescribing PHARMAC-funded PrEP have been extended in NZ, allowing any confident GP or nurse practitioner to prescribe PrEP using the “PrEP Special Authority” for eligible patients. This provides a broader access in primary care to patients seeking PrEP. For more information please see https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/prep-for-hiv/