Pre-exposure prophylaxis (PrEP)

Clinical description

• PrEP is being rolled out as a public health intervention for HIV prevention in Malawi.
• Offer PrEP as an additional primary prevention method for HIV negative persons who are at

substantial risk of acquiring HIV (see separate PrEP guidelines). Emphasize the need for combination with other HIV prevention methods such as consistent condom use, VMMC, etc.

• PrEP involves:

o Taking one daily fixed-dose combination tablet of ARVs (TDF/3TC)

o HIV testing every 3 months before any drug refill o STI screening before any drug refill o Adherence support o Renal function monitoring before initiation then annually o Baseline testing for HepB infection

• Eligibility criteria for PrEP:

o At substantial risk of acquiring HIV o Willingness to take daily PrEP as prescribed o Confirmed HIV Negative o No signs of acute HIV infection (AHI)

o Above 15 Years of age o Body weight 30kg+ o eGFR >60ml/min, no renal disease o No Contraindications to TDF/3TC

• TDF/3TC is the preferred PrEP regimen for Malawi.

o Tenofovir/emtricitabine (TDF/FTC) can be given as an alternative.

• The following tests need to be conducted before an individual is initiated on PrEP:

o HIV test o Serum creatinine test o Hepatitis B surface antigen

• More details on PrEP are included in the PrEP guidelines for Malawi

112 Post exposure prophylaxis (PEP)