Pre-exposure prophylaxis (or PrEP)
Pre-exposure prophylaxis (or PrEP) is a prescription medication that helps prevent HIV infection. PrEP involves working with a healthcare provider to make an individualized plan to take medication to prevent HIV. Clinical trials have shown that PrEP is 99% effective at reducing sexual transmission of HIV. As of January 2019, the U.S. Food and Drug Administration (FDA) has approved three medications as PrEP for HIV in adults and adolescents weighing at least 35 kg (77 lb.):
- Truvada or F/TDF (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg)
- CDC Clinical Guidelines identify Truvada as the most commonly prescribed medication for PrEP (including PWID) who meet criteria for PrEP use.
- Descovy or F/TAF (tenofovir alafenamide 25 mg/emtricitabine 200 mg)
- F/TAF is not approved for use by cis-gender women and is not for use during pregnancy
- Apretude (long-acting injectable cabotegravir 600 mg)
Key Points About PrEP
- PrEP medication is prescribed by a health care provider. People interested in PrEP can work with a healthcare provider to determine how PrEP can be tailored to their individual needs and circumstances. For a referral to a PrEP provider, contact the HIV Prevention Coordinator – Taylor Holsinger at 907-269-5221.
- PrEP is only for people who are not living with HIV. HIV testing should be conducted before starting PrEP and repeated every three months for oral PrEP. Testing may be done by the healthcare provider or at a conveniently located community-based organization (CBO), healthcare facility or lab. If a person has chosen injectable PrEP, HIV testing is done every 8 weeks during the visit for injection.
- Some people benefit from counseling and support for taking the medication regularly. If this is needed, the person can talk with the healthcare provider, a trusted CBO, a peer worker, or other provider. If you need assistance being connected for support, contact the HIV Prevention Coordinator – Taylor Holsinger, 907-269-5221.
- Long-acting injectable PrEP is an important option for people whose life circumstances make it difficult to consistently take an oral medication as prescribed.
- People at risk for HIV are also at risk for STDs. Counseling about using condoms to prevent STDs and periodic screening for STDs is important should be provided during testing appointments.
- PrEP medications are not effective for treating HIV infection. If you acquire HIV while taking PrEP, the provider who conducted the HIV test should either provide HIV medical care or refer you to a healthcare provider who can provide HIV care. There is no evidence that having taken PrEP will impact the effectiveness of HIV treatment, people who acquire HIV while on PrEP can be successfully treated with HIV medications.
Frequency of PrEP Use
You and your healthcare provider can work together to decide the best way for you to use PrEP. There are three different ways that people take PrEP:
- Daily PrEP: Daily PrEP involves people of any gender identity taking 1 pill once a day, every day. It is for people who have possible exposure to the HIV virus on a frequent basis, or an unpredictable basis. An important benefit of daily PrEP is that the person is always protected and can establish a daily habit of taking the medication. Daily PrEP with Descovy may be a good option for non-cis females who have difficulty tolerating Truvada, including people who have kidney disease or osteoporosis.
- On-Demand PrEP: On-demand PrEP is only for cis-gender men who have sex with men (MSM). On-demand PrEP involves taking 2 pills, 2-24 hours before a possible sexual exposure to HIV, and then continuing to take 1 pill each day until 2 days after their last possible sexual exposure. The only PrEP medication approved for on-demand use is Truvada. On-demand PrEP is for cis-gender MSM who have occasional risk for HIV that can be predicted at least 2 hours in advance.
- Long-Acting Injectable PrEP: Long-acting PrEP is taken by injection by anyone who is eligible for PrEP and weighs at least 77 pounds. Long-acting PrEP is for people who are able to attend regular in-office medical appointments to receive the injections. It is for people who are comfortable getting the injection in the buttock area.
It is important to talk to your healthcare provider about whether daily PrEP, on-demand PrEP, or long-acting injectable PrEP is right for you.
Where to go for PrEP
Any physician, nurse practitioner, or physician assistant can prescribe PrEP. It is important to have a healthcare provider who can work with you to individualize PrEP to your needs and circumstances. Not all health care facilities are prepared to administer long-acting injectable PrEP. Healthcare facilities who are known to routinely prescribe PrEP in Alaska are:
- Planned Parenthood (Anchorage & Fairbanks)
- Anchorage Neighborhood Health Center (Anchorage)
- Alaska Native Medical Center – Early Intervention Services (Statewide to Tribal Health Beneficiaries)
- Infectious Disease Management Group, Hope McGratty (Anchorage, with telehealth services available)
To find a PrEP provider near you, visit
locator.hiv.gov. If you need assistance locating a PrEP provider or would like a PrEP referral, contact the HIV Prevention Coordinator – Taylor Holsinger at 907-269-5221.
Paying for PrEP
Most health insurance plans, including Medicaid and Medicare, cover the cost of PrEP without co-pays. This includes medication, medical appointments, and lab tests associated with PrEP. Some health insurance plans may require prior approval. For people without access to health insurance with prescription drug coverage, financial assistance may be available. If you need information about financial assistance options for PrEP, contact the HIV Prevention Coordinator – Taylor Holsinger at 907-269-5221.
Post-Exposure Prophylaxis (PEP)
Post-exposure prophylaxis (PEP) is a medication that is taken to prevent HIV infection AFTER a possible exposure to the HIV virus. PEP should only be used in emergency situations and must be started with 72 hours after a possible exposure to HIV. If taken within 72 hours after a possible exposure, PEP is highly effective in preventing HIV.
Talk to your healthcare provider, an emergency room doctor, or an urgent care provider immediately about PEP if you think you’ve recently been exposed to HIV:
- During sex (for example if a condom breaks, or someone discloses their HIV status afterwards)
- Through sharing needles, syringes, or other equipment to inject substances, or
- If you have been sexually assaulted.
The sooner you start PEP, the better. Every hour counts. If you are prescribed PEP, you’ll need to take it daily for 28 days.
Emergency Use PEP
- PEP is given after a possible exposure to HIV
- PEP is not for regular use and should not be used as a substitute for other HIV prevention methods (condoms, PrEP)
- PEP is not the right choice for people who may be exposed to HIV frequently. If you are at ongoing risk for HIV, such as through repeated exposure via sexual contact, talk to you healthcare provider about PrEP (pre-exposure prophylaxis).
Recommended PEP Regimen
All persons offered PEP should be prescribed a 28-day course of a 3-drug antiretroviral regimen. Since adherence is critical for PEP efficacy, it is preferable to select regimens that minimize side effects, number of doses per day and the number of pills per dose.
According to the CDC, the preferred PEP regimen for otherwise healthy adults and adolescents is tenofovir disoproxil fumarate (TDF) (300 mg) + emtricitabine (FTC) (200 mg) once daily PLUS raltegravir (RAL) (400 mg) twice daily or dolutegravir (DTG) (50 mg) once daily.
The current and preferred regimen is generally safe and well tolerated. Patients usually experience only mild side effects on the preferred PEP regimen. In almost all cases, the benefits of PEP as HIV prevention outweigh any other risk posed by the medication.
Paying for PEP
Private insurance, Medicaid, Medicare, and worker’s compensation will usually pay for PEP. If you cannot get insurance to cover the medications, you can apply for free PEP medications through the medication assistance programs run by the manufactures of the medications. These requests can be handled urgently in many cases to avoid a delay in getting medicine. Applications can be completed online, by phone, or by fax through
Gilead or
NASTAD’s Patient Assistance Tool.
PrEP & PEP Resources