Pre-Exposure Prophylaxis (PrEP)-Associated HIV Monitoring and Self-Testing

Abstract

Background: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) encompasses the use of antiviral medications to prevent HIV acquisition in individuals without HIV who are at risk. Currently available HIV PrEP medications are nucleoside reverse transcriptase inhibitors and integrase inhibitors. HIV testing is required to confirm that patients do not have an HIV infection before PrEP, when restarting PrEP after a long pause, and during ongoing maintenance of PrEP.

Content: This article reviews current practices and recent developments in PrEP. Daily oral HIV PrEP is a common approach for HIV PrEP. The challenge with oral HIV PrEP is medication adherence. Recently, long-acting injectable medications for HIV PrEP have become available, which may improve adherence. HIV testing plays a critical role in PrEP programs. Methods for HIV testing for PrEP programs include laboratory-based antigen/antibody immunoassays, rapid testing with reflex confirmation, and RNA testing. The World Health Organization encourages the use of rapid HIV assays for self-testing because provider-administered testing may be a barrier to PrEP uptake. Currently available HIV self-testing (HIVST) methods are primarily antibody-based rapid assays. To improve the effectiveness of HIV PrEP, a greater range of medications, including novel long-acting antiretroviral agents, broadly neutralizing antibodies, and other drugs, are needed. Additionally, more accessible PrEP service delivery and high-sensitivity HIV tests, especially nucleic acid-based HIVST methods, are warranted.

Summary: HIV PrEP and related monitoring are essential parts of HIV prevention. More effective medications will improve the effectiveness of HIV PrEP, and more accessible PrEP service delivery and high-sensitivity HIV tests, especially HIVST methods, can improve HIV prevention with PrEP.