PrEP Provider Toolkit

PrEP Initiation

Primary Care Considerations

General health screening
Vaccinations
Family Planning

General health screening

Sometimes, patients engaged in PrEP care do not routinely see other providers to address other aspects of preventive medicine. PrEP follow-up visits are generally straightforward and can be quick visits. Utilize this opportunity to incorporate these Grade A and B United States Preventive Services Task Force (USPSTF) recommendations. ₍₂₉₎

Recommendation	Indication	Test (most commonly used)
Cervical Cancer Screening	Women 21-65yo	Pap-smear (w/ or w/ out HPV)
Colorectal Cancer Screening	Adults 45-75yo	FIT, colonoscopy
Intimate Partner Violence	Women of reproductive age	PVS, AAS
Latent Tuberculosis	Adults with a risk factor: born or lived in countries with high TB prevalence, lived or is living in homeless shelters or correctional facilities, currently homeless, etc.	QuantiFERON-TB Gold, TST (PPD)
Hypertension	All adults	Blood pressure
Diabetes	Adults 35-70yo with BMI>25	HbA1c
Depression	Everyone	PHQ-2/ PHQ-9 EPDS in postpartum and pregnant women
Folic Acid to Prevent Neural Tube Defects	All women planning or capable of pregnancy	Part of Sexual History (6 P’s)
Primary Prevention of Cardiovascular Disease With Statin Medication	Adults 40-75yo	ASCVD Risk Calculator
Tobacco Smoking Screening and Cessation Counseling	All adults	Directly Asking and Counseling
Alcohol Abuse Screening	All adults	AUDIT-C
Drug Abuse Screening	All adults	NIDA Quick Screen-C
Table 9. Relevant Screening Recommendations

Vaccinations

For the purposes of PrEP, the following vaccinations are most relevant.
Source: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-mmr

Vaccine	Indication
COVID-19	Primary series and boosters recommended for everyone.
Hepatitis A	No immunity based on labs.
Hepatitis B	No immunity based on labs (HBsAb<10mIU/mL)
Human Papillomavirus	Recommended up to 26yo. If not previously vaccinated, shared decision with patients between 27-45yo
Hypertension	All adults
Influenza	Recommended for everyone, annually.
Meningococcal B	Shared decision for patients 16-23yo
Monkeypox ₍₃₀₎ Centers for Disease Control and Prevention. (2022). Monkeypox vaccination basics. Department of Health and Human Services. https://www.cdc.gov/poxvirus/monkeypox/vaccines/vaccine-basics.html	Rapidly changing guidelines based on local health departments though for currently: adults with risk factors such as MSM/TGWSM, engages in transactional sex, or had a known exposure.
Pneumococcal	Adults 19-64yo with a risk factor: alcoholism, cigarette smoker, DM, etc.
Tetanus, diphtheria, and pertussis (Tdap)	Booster (Td or Tdap) generally recommended every 10 years
Zoster	All adults over 50yo
Table 10. Relevant Vaccination Recommendations

Family Planning

Given that PrEP is most often discussed along with sexual practices, it is good practice to incorporate components of family planning into your approach. There continue to be high rates of unintended pregnancies, particularly among the same groups disproportionately affected by HIV. ₍₃₁₎ At a time when women’s reproductive rights are constantly being challenged, it is increasingly important to provide guidance, support, and comfort to women of childbearing potential. Utilize "the 6 P’s” framework to expand on topics related to family planning and reproductive health.