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.
Australian PrEP Clinical Guidelines
New Zealand PrEP Clinical Guidelines
HIV PrEP Training
PrEP Provider Locator
PBS Changes to PrEP Prescribing
ASHM's submission to the Pharmaceutical Benefits Advisory Committee to change the PBS criteria for prescribing PrEP has been successful.
From 15 January 2021, it will be easier than ever to prescribe PBS-funded PrEP, making PrEP more accessible.
The removal of high and medium HIV risk categories, and aligning them with the PrEP suitability criteria in the 2021 updated ASHM PrEP guidelines
The removal of an age restriction where a patient was required to be 18 years or older
The expansion of the window for a negative HIV test result before treatment to *4 weeks, assisting access for rural and remote patients
The restriction level has been reduced from “Authority Required” to a “Restricted Benefit” to support broad access for patients who are at risk of HIV infection.
You can read the PBS Public Summary Document here.
* The ASHM PrEP Clinical guidelines recommend patients start PrEP within 7 days of the day that their HIV-negative test was performed however, this might not always be possible for patients living in rural and remote areas. HIV testing must be repeated every 3 months when patients attend for a prescription refill. This requirement for quarterly visits should be explained to patients during the initial discussion about whether PrEP is appropriate for them.
PBS Delisting of Truvada®
From 1 April 2020 Truvada® (emtricitabine/tenofovir disoproxil fumarate) for HIV treatment and for pre-exposure prophylaxis (PrEP) was delisted from the Pharmaceutical Benefits Scheme (PBS). ASHM have received reports from community that despite this, Truvada® is still being written on some scripts, causing confusion at pharmacies and in some cases, patients are being charged up to $170 per script.
Please do not use the drug name Truvada® on your scripts. Instead, choose one of the alternatives below.
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).
The listed alternatives are all indicated for PrEP on the PBS general schedule, and are brand equivalent. See the PBS listings here.
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.
What is PrEP
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.
Access to PrEP in Australia
There are three ways to access HIV pre-exposure prophylaxis (PrEP) in Australia:
1. Through the Australian health-care system
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.
2. Private script for supply from Australian pharmaceutical manufacturer
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.
3. Through personal importation or purchase
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.
Access to PrEP in New Zealand
There are 3 ways to access HIV pre-exposure prophylaxis (PrEP) in New Zealand (NZ):
1. Publicly funded PrEP
For people eligible for publicly funded health care, PrEP will be funded provided that they meet the NZ Pharmaceutical Management Agency, PHARMAC, funding criteria for emtricitabine with tenofovir disoproxil. Any relevant prescriber can write a script for PrEP which can be taken to any pharmacy for dispensing. If PrEP is accessed in this way, a $5 co-payment at the pharmacy is made.
2. Private script for supply from pharmacy
Any doctor can write a private script for PrEP. The brand stocked in NZ is currently produced by Teva Pharma (New Zealand) Limited. Patients can have this script dispensed at a community pharmacy. The cost for a private script is higher than for publicly funded PrEP; depending on pharmacy mark-up, each bottle of 30 pills will cost approximately NZD$90-110. This option is generally used by people who are not eligible for publicly funded PrEP and who do not feel comfortable using personal importation.
3. Through personal importation
If a person is not eligible for publicly funded PrEP, 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. A script from a clinician is still required before ordering online. There are multiple overseas suppliers who will supply PrEP for import into NZ at a range of costs. The Ending HIV website has more information on personal importation.
Information on clinical resources and training supporting the HIV workforce
ASHM continues to support the workforce to ensure access to PrEP and best practice in guidelines, training and resources:
ASHM currently delivers PrEP training to GPs and practice nurses in Australia and New Zealand. Please check the ASHM training page for upcoming courses.
HIV PrEP Update for Primary Care Providers Webinar
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 the ASHM training page.
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).
Decision Making in PrEP tool
This new 2-page Decision Making in PrEP tool provides a prescribing pathway that 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.
Download the National Decision Making in PrEP Tool
Download the New Zealand Decision Making in PrEP Tool
Download the NSW Decision Making in PrEP Tool
Download the WA Decision Making in PrEP Tool
For expanded details, see the ASHM PrEP Clinical Guidelines or PrEP New Zealand Clinical Guidelines
PrEP dosing guide
The PrEP dosing guide is intended to help clinicians in making the decision whether daily PrEP or on-demand PrEP is suitable for the patient.
This resource also gives examples of the different dosing options and explains how to prescribe it.