1. HIV Post Exposure Prophylaxis
Adjunct A/Prof Levinia Crooks AM
Chief Executive Officer
Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine
Public Health and Human Biosciences, La Trobe University
Centre for social research in health, university of new south wales
Supporting the HIV, viral hepatitis and sexual health workforce

2. ASHM and our role in PrEP
Professional society supporting and representing the HIV, viral hepatitis and sexual health workforce
Work closely with sector partners, professional and community organisations
Australia and New Zealand and work collaboratively with professional and workforce development oranisations in the Asia and Pacific regions
Coordinated Australian National PEP Guidelines in 2001
National PrEP Guidelines in 2015 (being updated now)
Communiques, training and resources for clinicians
Partner with community agencies providing advice to consumers

3. PrEP Status in Australasia
Truvada ® approved by the Australian Therapeutic Goods Administration (TGA) in May It is now listed on the Australian Register of Therapeutic Goods (ARTG). Not listed in New Zealand
Application before the Pharmaceutical Benefits Advisory Committee (PBAC), if supported will be subsidised under the Pharmaceutical Benefits Scheme. Next meeting July 2016, if supported likely to be available late 2016 – early 2017.
PrEP is not licensed in New Zealand

4. Ways drugs can be accessed
The Australian government allows people to import drugs for personal use through the Personal Importations Scheme scheme
This means that proprietary drug as well as generic drug can be imported
Online internet pharmacies sell Truvada and generic bioequivalents
Now that the drug is on the ARTG it will also be able to be purchased for full price from the manufacturer

5. Demonstration Projects
A number of research projects make PrEP available
VicPrep 115 – Victoria
PreLude 300 – New South Wales
QPREP 50 – Queensland
Each of these has now been extended and a less extensive protocol used to scale-up with the view to realising a public health outcome of reducing new infections.

6. Quality when buying on line
FDA has approved a number of generic providers for supply to PEPFAR programs
Gilead has drugs produced under licence by Mylan and marketed through Alphapharm (in some countries)
Drug being used in Australia extension projects a mix of Gilead and Mylan/Alphapharm
Community organisations can provide information about approved suppliers
Avoid on-line services which make false claims
Can test drug to determine bioequivalence

7. Guidelines and Guidance
ASHM Australian Guidelines
Jurisdictional Guidelines
Study Protocols (more stringent in first phase)
Study protocols (less stringent in second phase)
Guidance to clinicians assisting people to self import

8. Who should access PrEP
It is thought that many people acquire and then transmit HIV before they know they are infected
SO WHO SHOULD HAVE PREP:
People at greatest risk of acquiring and transmitting HIV, if they were to acquire it
People at risk of acquiring HIV
People who find consistent condom use difficult

9. Some observations
People (mainly MSM) are going on PrEP and staying on for duration of studies so far
MSM interested in PrEP already have high STI burden, and this continues
Study participants are taking pills at a regular rate with the majority always maintaining therapeutic dose
Self report acceptability and feeling of taking control
Bone mineral density and renal complications low
Very low or no transmissions, means there is no transmitted resistance

10. Next iteration of Guidelines
Will include:
Focus on transgender persons
Discussion of consideration of intermittent PrEP
Hepatitis C testing while on PrEP
Consideration of access for people outside of highest priority research participants

11. PrEP: part of comprehensive prevention strategy
Increase testing
Newly infected
Identification of people with established infection
Increase number of people on treatment
Reduce time between diagnosis and treatment
Remove barriers to starting treatment
Maintain people on treatment
Increase promotion of other prevention strategy
Condom use
STI screening

12. Regional Network Establish PrEP page on Regional Network Website
Upload and link regional and country information
Can also link information for patients
Website launched today 17 May 2016