4 d Supporting PrEP Users The Southern African HIV Clinician Society PrEP Guidelines is full of little gifts Condom use and PrEP What if user asks about stopping condoms ID: 671378
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Slide1
Clinical Management
Module
4
(d)
Supporting
PrEP
UsersSlide2
The Southern African HIV Clinician Society
PrEP
Guidelines is “full of little gifts”:Condom use and PrEPSlide3
What if user asks about stopping condoms?
Do not be
judgmental Explain that this is a valid choice but
PrEP prevents HIV but not STIs
PrEP prevents HIV but not pregnancyRegular
STI screening and management plan
Effective and acceptable contraception plan where indicated
Vaccinate against all vaccine-preventable STIs, e.g. hepatitis A and B and HPV where possibleSlide4
Full of little gifts:
Adherence
vs effective useSlide5
Full of little gifts:
Supporting
effective useSlide6
And the gifts keep coming:
Exclude
acute infectionSlide7
Exclude a
cute
HIV infectionHIV test before commencing or restarting PrEPAsk about missed dosesNegative HIV testClinical screen for symptoms acute HIV
Targeted examinationTime between last potential exposure and window period of tests usedSlide8
Exclude a
cute
HIV infectionIf symptoms/signs of acute HIV:At screeningPostpone PrEP until symptoms resolve AND
Follow up test 2-4 weeks later is negativeAt follow upContinue PrEP while awaiting results of HIV test
OR withhold PrEP until results availableIf PrEP taken consistently, breakthrough infection is unlikely – may put user at risk by withholdingSlide9
Exclude a
cute
HIV infectionSupport maximum effective useCounselling at each visitStop PrEP appropriatelyCounsel about steps required if restart PrEPSlide10
And the gifts keep coming:
Symptoms
of acute infectionSlide11
Common symptoms and signs
of
acute HIV infectionSymptommalaise
anorexia myalgias
headache sore throat sore glands
rash
Sign
fever, sweating
generalised lymphadenopathy
hepatosplenomegaly
non-exudative pharyngitis
orogenital
herpetiform
ulceration
truncal
rash (maculopapular or urticarial)
viral meningitis
Guillian-Barre
syndrome Slide12
And the gifts keep coming:
Combination
preventionSlide13
HIV p
revention
methodsBiomedical
condoms and lubricants
frequent HIV testing early access to ART
PEP and PrEP
VMMCSTI screening and treatment
needle syringe exchange and opioid substitution therapy for PWID
Psychosocial
education: risk and safer
sex
HIV
counselling and screening
reducing
no of
sex partners
reducing alcohol and substance abuse
addressing mental
health
Couple counselling/programming
harm reduction counselling and support for clients who use drugsSlide14
Acknowledgements
With thanks to:
The Southern African HIV Clinician Society (
Michelle
Moorhouse
)Wits Reproductive Health and HIV Institute
Anova Health Institute