DSHS PrEP Position Statement
Texas Department of State Health Services, January 14, 2019
DSHS, the U.S. Public Health Service, and the U.S. Centers for Disease Control and Prevention recommend that PrEP be considered for people who are HIV-negative and at elevated risk for HIV.
Pre-exposure prophylaxis, or PrEP, is a way for people who are at elevated risk of acquiring HIV to prevent getting HIV infection. The Food and Drug Administration has approved a once daily pill with a fixed-dose combination of two HIV medicines: tenofovir disoproxil fumarate and emtricitabine. It is prescribed and sold under the name Truvada®. When someone is exposed to HIV through sex or injection drug use, this combination of medicines can keep the virus from establishing a permanent infection. PrEP intervention also includes counseling on safer sex behavior, regular STD testing, and access to condoms. When taken as prescribed, PrEP reduces the risk of HIV acquisition by up to 92 percent.
PrEP is a highly effective intervention and provides an opportunity to curb rising HIV infections. It expands the prevention strategies available to those at very high risk, such as HIV-negative individuals who have an HIV-positive partner. PrEP has been extensively studied, and shows very high levels of effectiveness. The U.S. Food and Drug Administration has approved Truvada® to be used for PrEP in adolescents and adults who weigh at least 35 kilograms (77 pounds).
The clinical practice guidelines for PrEP from the U.S. Public Health Service outline the indications for PrEP use and provide criteria for determining a person's eligibility. The indications for PrEP and the recommendations for clinical follow-up and laboratory testing are the same for adolescents and adults. The guidelines require HIV testing to confirm HIV negative status before starting PrEP and emphasize the importance of adherence, risk-reduction counseling, and condom use to build on the protection provided by the medication. The guidelines are accompanied by a provider's supplement that includes additional information and tools for clinicians who prescribe PrEP.
PrEP medications cannot be purchased with DSHS HIV/STD prevention, care, and treatment funds, but there are important steps you can take now to make PrEP a reality for your clients.
Educate yourself - Get information from trusted sources, like the CDC, the National Institutes of Health, and the National Clinical Consultation Center.
Be a PrEP advocate with your clients
Break down barriers to PrEP - PrEP medications can be free or discounted for both insured and uninsured patients. There are several programs to assist with paying for PrEP, including manufacturer drug and co-pay assistance, Patient Access Network Foundation, and Patient Advocate Foundation.