PrEP Provider Toolkit: Addressing discontinuation

PrEP Provider Toolkit

PrEP Continuation Visit

Addressing discontinuation

The use of PrEP should always be a shared decision with your patients. Carefully discuss the following points without placing pressure on the patient to continue.

PrEP Continuation Patient Counseling Checklist
Address and document the reasons why the patient wishes to stop Ensure that the patient does not have +HBsAg as discontinuation may potentially lead to hepatic flares. Consider a referral to hepatology for monitoring and further management. Retest for HIV and STIs (+pregnancy status, if applicable) Encourage barrier methods, routine testing, and risk-reduction strategies if the patient continues to engage in high risk sex and/or IVDU Share with the patient that PrEP can be restarted whenever they want Protection from oral PrEP will wane after a week If the patient discontinues cabotegravir (Apretude), there is risk of developing HIV resistance during the “tail period” which is when the drug remains in the body but not at adequate concentrations to prevent HIV infections. If PrEP indications still exist, start on oral PrEP with either F/TDF or F/TAF within 8 weeks of last injection. At the minimum, q3 month HIV-RNA testing and monitoring is recommended for a year after the last cabotegravir (Apretude) injection
Table 12. PrEP Discontinuation Patient Counseling Checklist

PrEP Continuation Patient Counseling Checklist

Address and document the reasons why the patient wishes to stop
Ensure that the patient does not have +HBsAg as discontinuation may potentially lead to hepatic flares. Consider a referral to hepatology for monitoring and further management.
Retest for HIV and STIs (+pregnancy status, if applicable)

Encourage barrier methods, routine testing, and risk-reduction strategies if the patient continues to engage in high risk sex and/or IVDU

Share with the patient that PrEP can be restarted whenever they want
Protection from oral PrEP will wane after a week
If the patient discontinues cabotegravir (Apretude), there is risk of developing HIV resistance during the “tail period” which is when the drug remains in the body but not at adequate concentrations to prevent HIV infections.

If PrEP indications still exist, start on oral PrEP with either F/TDF or F/TAF within 8 weeks of last injection. At the minimum, q3 month HIV-RNA testing and monitoring is recommended for a year after the last cabotegravir (Apretude) injection

Table 12. PrEP Discontinuation Patient Counseling Checklist