PrEP

Initial consultation [-] planning

EXPLANATORY NOTES
[+] yes, present, positive
[-] no, absent, negative
[~] equivocal
[\] not performed, not applicable
[?] unknown, unsure
# comment

PRESENTING COMPLAINTS OR ISSUES
Reasons for visit:
[+] PrEP initial consultation

Indications:
[+] HIV acquisition risk
[-] patient request based on self-assessed risk

Contraindications for PrEP:
[-] chronic HIV infection. 
[-] possible acute HIV infection (exposure in last 72 hours [-] may need PEP). 
[-] significant renal impairment (eGFR <60).

Precautions for PrEP:
[-] mild renal impairment (eGFR 60-90). 
[-] concurrent nephrotoxic drugs. 
[-] acute or chronic HBV infection. 
[-] pregnancy/planned pregnancy. 
[-] lactating.

IMMUNISATIONS
[+] Hepatitis B vaccination completed.

MANAGEMENT PLAN
Laboratory tests requested:
[+] HIV testing.
[-] Hepatitis B serology (if not vaccinated).
[+] Hepatitis C serology.
[+] STI screen (syphilis, gonorrhoea, chlamydia).
[+] eGFR.
[+] Urine protein/creatinine ratio.
[-] Pregnancy test (women of childbearing age, not on effective contraception).

PrEP (tenofovir disoproxil 300 mg [+] emtricitabine 200 mg):
[-] Daily PrEP
  - One tablet daily.
  
[-] On-demand PrEP
  # Suitable for cis-gender MSM who express a preference for on-demand† PrEP, who have at-risk sex less than twice a week and who can plan ahead for at-risk sex at least 2 hours in advance.  
  # 2-1-1 rule: two tablets taken 2-24 hours before sex, one tablet taken 24 hours after the first dose and one tablet taken 48 hours after the first dose.

Immunisations:
[-] HBV (if not immune)
[-] HPV (if not previously immunised)
[-] HAV (MSM)
[-] MPox (MSM)

Other:
[+] behavioural safety strategies (eg, barrier protection)
[+] side effects
[+] missed pill management

Review consultation

EXPLANATORY NOTES
[+] yes, present, positive
[-] no, absent, negative
[~] equivocal
[\] not performed, not applicable
[?] unknown, unsure
# comment

PRESENTING COMPLAINTS OR ISSUES
Reasons for visit:
[+] PrEP review consultation

Last review date:

Current PrEP use:
[-] daily
[-] on-demand

Problems:
[-] side effects
[-] missed doses
  Details:

[Diagnostic investigation results]

Pathology: 
  Every 3 months:
    Date performed: 
      HIV Ag/Ab: 
      Hepatitis C Ab (people who inject drugs or MSM with elevated risk): 
      Syphilis serology: 
      Gonorrhoea/Chlamydia PCR: 
      Pregnancy test: 
  Every 6 months: 
    Date performed: 
      eGFR: 
      Urine protein/creatinine ratio: 
  Every 12 months:
    Date performed: 
      Hepatitis BsAg (if not vaccinated): 
      Hepatitis C Ab:

ASSESSMENT
Problems identified:
[+] 
[-]

MANAGEMENT PLAN
PrEP (tenofovir disoproxil 300 mg [+] emtricitabine 200 mg):
[-] Daily PrEP
  - One tablet daily.
  
[-] On-demand PrEP
  - Suitable for cis-gender MSM who express a preference for on-demand† PrEP, who have at-risk sex less than twice a week and who can plan ahead for at-risk sex at least 2 hours in advance.  
  - 2–1–1 rule: two tablets taken 2–24 hours before sex, one tablet taken 24 hours after the first dose and one tablet taken 48 hours after the first dose.

Diagnostic investigations requested:
# Scheduled before next review
  Next review date: 
  Investigations requested:
  Every 3 months: 
    [+] HIV Ag/Ab
    [+] Hepatitis C Ab (people who inject drugs or MSM with elevated risk)
    [+] Syphilis serology
    [+] Gonorrhoea/Chlamydia PCR
    [?] Pregnancy test
  Every 6 months: 
    [-] eGFR: 
    [-] Urine protein/creatinine ratio: 
  Every 12 months:
    [-] Hepatitis BsAg (if not vaccinated): 
    [-] Hepatitis C Ab:

Immunisations:
[-] HBV (if not immune)
[-] HPV (if not previously immunised)
[-] HAV (MSM)
[-] MPox (MSM)

Other:
[+] behavioural safety strategies (eg, barrier protection). 
[+] side effects. 
[+] missed pill management.

Notes

Typical laboratory testing schedule*

Baseline - HIV serology; Hepatitis B serology; Hepatitis C serology; STI screen (syphilis, gonorrhoea, chlamydia); eGFR; Urine protein/creatinine ratio; Pregnancy test (women of childbearing age, not on effective contraception)
30 days - HIV serology
3 months - eGFR, Urine protein/creatinine ratio
Every 3 months - HIV serology; Hepatitis C serology (people who inject drugs or MSM with elevated risk); STI screen (syphilis, gonorrhoea, chlamydia); Pregnancy test (women of childbearing age, not on effective contraception)
Every 6 months - eGFR; Urine protein/creatinine ratio
Every 12 months - Hepatitis C serology; Hepatitis B serology (if not vaccinated)

PrEP

Initial consultation [-] planning

Review consultation

Notes

Typical laboratory testing schedule*

Related items

External links

Clinical guidelines

Patient information