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PrEP has been a major discussion point in the 2017 ASHM conference. In a joint symposium with the 2017 Sexual Health Conference, multiple speakers spoke of the rollout of PrEP in Australia and New Zealand. A/Prof Edwina Wright discussed ‘PrEP in Future Australia: How will it look?”
Edwina invited us to imagine the future of PrEP in Australia if PBS listing were to occur in 2018. One of the key points made was the need for rapid up-scaling of PrEP provision in the community. There have already been signs of over-saturation of clinics involved in the current PrEP studies, and PBS listing of PrEP would likely further overwhelm these resources. This leads to the question of which providers would be able to assist in providing appropriate PrEP counselling – other practitioners besides medical practitioners could play a role here, including nurse practitioner and pharmacists. Criteria for PBS prescribing would likely exist to obtain authority – this would be based on the recently published ASHM guidelines on PrEP and would require individuals to be HIV negative, have normal renal function and aged over 18.
Another key issue raised by Edwina as well as numerous other speakers during the conference relate to inequity of access. Currently those accessing PrEP come from a similar demographic – gay, educated, Australian-born and employed individuals. Individuals from culturally and linguistically diverse backgrounds, those from lower socio-economic status, and those in rural communities are under-represented. Further strategies are required to try and reach out to these communities.
Another issue that requires further investigation is that of potential toxicity. As PrEP contains TDF, the long-term risk and toxicity to renal function or bone health remains to be determined. A PrEP registry could play an important role here to allow long-term follow-up of potential toxicity. Continuous follow-up of individuals on PrEP also remains vital, not only in assessing for potential complications, but also for ongoing routine screening of other STIs.
This session highlighted the need for increasing preparedness of clinicians in the community in being able to manage and counsel patients requesting PrEP, the number of which is likely to increase if/when PrEP becomes PBS listed. In addition, those currently accessing PrEP through clinical trials may prefer to see their general practitioners or other health practitioners in the community to continue receiving PrEP once the trial ends. Several PrEP resources are available to clinicians including the ASHM PrEP guidelines and an online PrEP module available on the ASHM website.