People thinking about using PrEP need to be given enough information about PrEP and other prevention options to help them decide whether PrEP is appropriate for them.

The initial assessment before a person begins PrEP needs to include the individual’s risk of HIV infection; tests for HIV, sexually transmitted infections, pregnancy, hepatitis B and kidney function; and evaluation of any medical problems that could be seroconversion symptoms. People beginning PrEP may benefit from advice on developing routines of pill taking.

When taking PrEP, regular HIV testing (to prevent the development of drug resistance) and regular monitoring for side-effects (especially kidney problems) are essential. These visits also provide an opportunity to screen for sexually transmitted infections, engage patients with discussions around sexual risks, offer other behavioural interventions, and make condoms available.

The CDC’s guidelines include detailed recommendations on how to provide PrEP.

In the UK, sexual health (GUM) clinics are the obvious location as many people who would benefit from PrEP already attend them and many staff are skilled in discussing risk behaviours. Providing PrEP requires experience of prescribing antiretrovirals, which many sexual health clinicians have. Partnerships with community organisations may help raise awareness of PrEP in the wider community.