HIV Pre-exposure prophylaxis PrEP (Guidelines)

Eliminating new HIV transmissions by 2030 is a Scottish government and WHO target. Eliminating new transmissions requires a multi-pronged approach including HIV testing, early treatment of people newly diagnosed with HIV, and also prevention of HIV for those at on-going risk.

What is PrEP?

HIV Pre-exposure prophylaxis currently comes as a single tablet that contains 2 antiretrovirals – tenofovir disoproxil 245mg /emtricitabine 200mg. It can either be taken daily (daily PrEP) – at least 4 tablets taken per week in order to be effective, or event based PrEP, where 2 tablets are taken 2-24 hours prior to a potential exposure event, 1 tablet taken 24hs after the exposure and another 48hours after the exposure (4 tablets taken in total).
PrEP is provided as part of a package that also involves:

• Regular sexual history and risk assessment – usually every 3 months
• Regular screening for STI and blood borne infections (BBV) – usually every 3 month
• Regular renal monitoring – every 3-12months depending on patient age and co-morbidities
• Health promotion and prevention
  • Condom provision
  • Vaccination for HPV, Hepatitis B and Hepatitis A

More information can be found at

• NHS inform HIV PrEP (see resources) 
• PrEP in Scotland (see resources)

Who should PrEP be offered to?

HIV PrEP is recommended for people who have on going risk of acquiring HIV. This includes

• Gay and bisexual and other men who have sex with men (GBMSM) who have unprotected anal sex (receptive or insertive) with casual partners
• Transgender women who have unprotected sex with casual partner(s)
•  Anyone who has a partner with untreated HIV infection
•  People who have unprotected sex with partners from high prevalence areas
•  Anyone with other equivalent risk of acquiring HIV infection

How can people access PrEP in Highland?

Referral to Highland Sexual Health (see resources) 

For remote and rural patients, we sometimes request the GP to help with monitoring tests to prevent travel to our clinic in Inverness. We would discuss this on an individual basis with the patient and GP as appropriate. Home sampling tests can be used for STI screening, and ITR may be used for renal monitoring where available