PrEP (Pre Exposure Prophylaxis)
What is PrEP?
PrEP is a course of HIV drugs taken by HIV negative people before and after sex to reduce the chance of getting HIV. Results in trials have been very successful, with PrEP significantly lowering the risk of someone becoming HIV positive without causing major side effects. The medication used for PrEP is a tablet which contains tenofovir and emtricitabine (sometimes known as Truvada).
How does PrEP work?
Taking PrEP before and after being exposed to HIV means there is enough of the drug inside you to block HIV if it gets into your body – before HIV it has the chance to infect you.
PrEP does not prevent other STIs. Condoms, when used consistently and correctly, are the best way to prevent the transmission of HIV and other STIs.
Is PrEP available in Ireland?
From 4th December 2017, a generic version of the medication (Emtricitabine/Tenofovir disoproxil Teva) will be available in pharmacies in the Republic of Ireland. It can be only be bought with a doctor’s prescription.
Teva Pharmaceuticals Ireland (Teva) are supplying this more affordable, generic version.
How do I get PrEP?
You must have a doctor’s prescription to get PrEP.
It is important to have an HIV test before you start PrEP, as PrEP can only be used if you are HIV negative.
As such, one of the best places to get a prescription is from a HIV/STI testing clinic.
There are two PrEP Monitoring Clinics (based in Dublin) where you can get a prescription.
- Gay Men’s Health Service (GMHS), Baggot Street Hospital, 18 Upper Baggot Street, Dublin 4, Tel: 01 669 9553; 087 941 0934; Email email@example.com
The clinic takes place on Thursdays from 10am to 12 noon offering PrEP monitoring tests and support for men who have sex with men, rapid HIV tests, and full STI screening. This is a PrEP monitoring service only and PrEP is not available at the clinic. Also provides prescriptions for PrEP.
- Prevention Support Clinic at Clinic 6, Mater Misericordiae University Hospital, Eccles Street, Dublin 7. Appointment only clinic on Tuesday afternoons. Tel: (01) 803 2063 to make an appointment or email firstname.lastname@example.org.
GPs can also provide a prescription but some GPs may not be aware of PrEP. If you go to your GP, be sure to ask for a ‘4th generation’ HIV blood test first and follow the ‘Advice before taking PrEP‘ – see below.
The HSE has published a document offering practical guidance on PrEP for healthcare workers in Ireland. You could refer your GP (or any doctor) to this guide to ensure that you get the best health care possible before starting PrEP.
View / download the document here:
Teva Pharmaceuticals Ireland has also produced a number of guides for those prescribing PrEP.
Emtricitabine/Tenofovir (PrEP) Prescriber guides:
- Educational brochure for prescribers pertaining to renal management
- PrEP educational brochure for prescribers
- PrEP checklist for prescribers
What pharmacies are stocking PrEP?
A list of pharmacies stocking PrEP can be viewed here (list supplied by Teva Pharmaceuticals Ireland).
This list is current as of 14th December 2017 and we will endeavour to keep this information updated regularly. The list of pharmacies is expanding daily and you can also ask your local pharmacy to order the medication in if they don’t currently stock it.
Do I have to pay for PrEP?
Due to the fact that the Health Service Executive (HSE) has not yet moved to reimburse PrEP, the medication will not be available to patients under the GMS or Drug Payment Scheme and must be paid for in full by you on presentation of a doctor’s prescription.
However, as Teva’s PrEP is a generic form of the medication it is expected to be up to 70% cheaper than the current cost of its branded equivalent.
How much will PrEP cost?
The recommended retail price is around €100 for a month’s supply of PrEP. Prices may vary in different pharmacies.
Advice before taking PrEP
The HSE has published an information booklet for people who are accessing PrEP themselves or are considering accessing PrEP.
View or download the booklet here:
Talk to a health advisor, nurse, or doctor at the clinic. They can help you if you are planning to take, or are already taking PrEP. It is important to have an HIV test before you start. PrEP can only be used if you are HIV negative. If you are already HIV positive and don’t know it, you could develop resistance to drugs that you will need for treatment.
Ask for a ‘4th generation’ HIV blood test. This is also called a ‘combined antigen/antibody’ test. This test can tell you your HIV status approximately four weeks ago. Most rapid (finger prick) tests are currently ‘3rd generation’. These tests tell you your HIV status approximately three months ago. So don’t rely on a rapid (finger prick) test alone before you start PrEP.
If you are just starting PrEP and have had a risk exposure to HIV in the last four weeks, have another 4th generation HIV blood test four weeks after starting, just to be sure an early infection was not missed. If you have flu-like symptoms and a recent HIV risk exposure it is advisable not to start PrEP. This is to ensure that these symptoms are not related to a recent HIV infection.
If you are starting PrEP after PEP (Post Exposure Prophylaxis), it is best to start immediately if you have ongoing risks. Ideally you should have an HIV blood test around the time you finish PEP/start PrEP plus another HIV blood test four weeks into taking PrEP.
Remember that unprotected sex while taking PrEP will reduce your risk of contracting HIV but not other STIs. Use condoms to reduce your risk of contracting other STIs and get tested regularly.
You will also need to have your kidney function checked. Kidney monitoring just involves a blood test for creatinine and a urine test for protein. These should ideally be done just before or on the day you start PrEP.
Advice while taking PrEP
Once you have started PrEP, health monitoring is really important.
Every 3-4 months:
- Have a ‘4th generation’ HIV blood test.
- Have a full screen for other STIs.
- Have a urine dipstick test for protein when you have your STI check up; if there is more than a trace, an additional blood or urine test can be sent off to be tested for kidney function.
Every 12 months:
- Have a blood test to check your kidney function.
More information about PrEP
Research on PrEP
Research has shown that PrEP is highly effective in preventing the sexual transmission of HIV as long as the medication is taken regularly and as directed. The PROUD study in the UK reported that PrEP reduced the risk of HIV infection by 86% for men who have sex with men (MSM). Read more about this study at www.proud.mrc.ac.uk.
In what countries is PrEP available?
Access to PrEP is expanding globally. The World Health Organisation (WHO) recommends that in all countries, PrEP should be available to MSM, alongside other HIV prevention interventions. The European Centre for Disease Prevention and Control (ECDC) advises European countries to consider integrating PrEP into their existing HIV prevention package for those most at-risk of HIV infection, starting with MSM.
Keep up to date about access to PrEP at www.prepwatch.org.
Sourcing/Buying PrEP online
In Ireland, it is against the law to supply prescription medication by mail order, including over the internet. The Health Products Regulation Authority (HPRA) provides information for the public in relation to sourcing medication over the internet. View/download the HPRA information leaflet ‘The dangers of buying prescription medicines online‘.
The Health Products Regulation Authority (HPRA) have increased surveillance of PrEP orders coming in to Ireland. Reports have been received of orders being intercepted by the HPRA and PrEP medicine being confiscated.
In addition to this, the HPRA have expressed particular concern about the legitimacy of the source of a recently seized supply of generic PrEP. The HPRA are also examining the websites people use to source PrEP.
There have been no reports from the HPRA or any other appropriate bodies stating that the medicine being sourced online is not effective as PrEP. However, sourcing medicine online does carry a level of risk and so we encourage caution if you intend to do so.
- If you are sourcing PrEP by any means, engage with your local sexual health service for testing and monitoring. Clinics want to see people who are taking PrEP so that they can look after them in the best possible way.
- If the HPRA intercepts a PrEP order it will be confiscated. Under no circumstances will the PrEP drug be released to you. Any amounts spent on purchasing the drug will be lost.
- If the HPRA contacts you about having placed an order for PrEP online – you are not in any trouble. If they ask you for information on how you ordered PrEP, you are under no obligation to respond. However, the role of the HPRA is to protect the public from illegitimate drugs and their suppliers – any information supplied by you will be used to better understand the circumstances around supply of medicines and protect the public from bogus suppliers.