Australian HIV organisations highlight guidelines around on-demand PrEP

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and Thorne Harbour Health have highlighted guidelines around on-demand PrEP following the recent HIV diagnosis of PrEP advocate Steve Spencer.

Spencer spoke to Star Observer about his diagnosis to in an interview conducted by The Institute of Many’s Nic Holas last week.

“Taking on-demand PrEP whilst seroconverting will put that method of dosing under scrutiny – however the research supports it as a legitimate and effective form of PrEP dosing and it is supported by doctors and health authorities across the globe,” Spencer said.

“So the fact that one individual seroconverted while using that dosing method out of the thousands upon thousands also using that method does not make it illegitimate.”

ASHM and THH today released statements highlighting resources around on-demand PrEP use, including a video explaining how the strategy works.

ASHM is the author of Australia’s clinical guidelines around PrEP, which say that daily dosing may offer close to 100 per cent efficacy at preventing HIV when used with high medication adherence, but which also include on-demand PrEP as a prevention strategy.

On-demand PrEP involves taking two pills taken 2 to 24 hours before potential sexual exposure to HIV, followed by one pill daily until 48 hours have passed after the last act of sexual intercourse.

ASHM Clinical Advisor Darren Russell, one of the co-creators of the on-demand PrEP awareness campaign ‘Whatever comes your way’, sits on the committee that reviews the PrEP clinical guidelines, and says there are a number of reasons someone might want to choose on-demand PrEP.

“Taking PrEP only around the time of sexual events allows for fewer tablets to be taken overall, resulting in less exposure to medication, potentially fewer side-effects, and lower costs,” Russell said.

“There is a body of evidence to support the use of on-demand PrEP, and it is estimated that tens of thousands of people around the world are choosing to take PrEP on-demand rather than daily.

“When it comes to daily PrEP use, there are only a very small handful of well-verified cases worldwide where an individual has acquired HIV while taking PrEP daily as prescribed.

“It is important to remember that while PrEP is highly effective at preventing HIV, like any other HIV-prevention method it is not 100 per cent effective.

“If you have any questions or concerns about on-demand PrEP, please speak with your clinician.”

With Spencer’s case prompting a significant conversation about the efficacy of PrEP and on-demand dosing, ASHM CEO Alexis Apostolellis noted that it is important to remind clinicians and the wider community that Australia’s clinical guidelines on the use of PrEP are evidence-based.

“All clinical guidelines produced by ASHM go through a rigorous development and review process, with input from some of the world’s top researchers and clinicians,” Apostolellis said.

“Clinicians need to understand the latest evidence to keep up with how a HIV-prevention method like PrEP is actually being used by the community, and our guidance on PrEP represents best-practice in evidence-based clinical guidelines.”

Thorne Harbour Health’s new video explaining on demand PrEP comes in response to “an increased interest in using on-demand PrEP among the communities we work with,” according to CEO Simon Ruth.

“It’s incredibly important that people understand how on-demand PrEP works before deciding to use this HIV prevention strategy.

“We’re at a point in the epidemic where we’re starting to realise the full potential of biomedical prevention.

“PrEP, alongside undetectable viral load through effective treatment, is leading the way as the most effective strategy at stopping the onward transmission of HIV,” Ruth said.

“With nearly half a million PrEP users worldwide, PrEP is proven to be incredibly effective at preventing HIV. Here in Victoria, we have seen one of the most progressive community conversations around using this tool for HIV prevention,” added Thorne Harbour President Chad Hughes.

“We need to keep pace with the communities we serve and ensure we provide them with evidence-based information so they can make an informed choice about looking after their sexual health and wellbeing.”

You can read ASHM’s full PrEP guidelines by clicking here.

For more general information around PrEP, visit www.thorneharbour.org/prep and endinghiv.org.au.