PrEP Provider Toolkit

Advanced Topics

Event-Driven PrEP (ED-PrEP)

Although the data is limited, event-driven PrEP (ED-PrEP) with F/TDF (Truvada) appears to be an efficacious alternative strategy, offering similar protection against HIV infections as daily dosing. ED-PrEP may be appropriate for patients who are MSM and do not prefer daily ingestion. There are a couple of important points to note and discuss with your patients:

Event-Driven PrEP Patient Counseling Checklist
ED-PrEP does not have FDA approval in the United States though existing studies show that it may be just as effective in preventing HIV infections as daily dosing Only F/TDF (Truvada) should be used for ED-PrEP Only indicated for individuals who are MSM to prevent HIV infections that occur sexually ED-PrEP may cause more significant GI side effects It should not be used if the patient has HBV infection or does not know their HBV status
Initial Dose: Take 2 pills 2-24 hours before sex Second Dose: Take 1 pill 24 hours after the initial dose Follow-up Doses: Take 1 pill 24 hours after the second dose (48 hours after the initial dose) If sexual activity continues, take 1 pill everyday and continue for 2 days after the last sexual event. Additional notes for follow-up doses: If a gap of <7 days occurs between sexual event, take 1 pill everyday and continue for 2 days after the last sexual event. If a patient has been off of PrEP for >7 days, restart the 2-1-1 cycle
Table 13. ED-PrEP Patient Counseling Checklist Source: https://checkhimout.ca/what-is-prep/resources/

Event-Driven PrEP Patient Counseling Checklist

ED-PrEP does not have FDA approval in the United States though existing studies show that it may be just as effective in preventing HIV infections as daily dosing
Only F/TDF (Truvada) should be used for ED-PrEP
Only indicated for individuals who are MSM to prevent HIV infections that occur sexually
ED-PrEP may cause more significant GI side effects
It should not be used if the patient has HBV infection or does not know their HBV status

The 2-1-1 Rule for PrEP on-Demand

Initial Dose: Take 2 pills 2-24 hours before sex
Second Dose: Take 1 pill 24 hours after the initial dose
Follow-up Doses: Take 1 pill 24 hours after the second dose (48 hours after the initial dose)
If sexual activity continues, take 1 pill everyday and continue for 2 days after the last sexual event.
Additional notes for follow-up doses:

If a gap of <7 days occurs between sexual event, take 1 pill everyday and continue for 2 days after the last sexual event.
If a patient has been off of PrEP for >7 days, restart the 2-1-1 cycle

Table 13. ED-PrEP Patient Counseling Checklist
Source: https://checkhimout.ca/what-is-prep/resources/