There are two main forms of HIV pre-exposure prophylaxis (PrEP): oral and injectable.

Oral PrEP

Oral PrEP involves taking medication to prevent HIV infection. There are two oral PrEP regimens: daily and on-demand (“2+1+1”).

Daily PrEP involves taking the medication regularly:

● 1 tablet every day for as long as there is a risk of acquiring HIV.

The daily regimen is suitable for people who have an ongoing or regular risk of acquiring HIV.

On-demand PrEP (PrEP 2+1+1) is also known as “event-driven,” “intermittent,” or PrEP on demand. The medication is taken according to the “2+1+1” regimen:

● 2 tablets at the same time, 2–24 hours before sex;
● 1 tablet 24 hours after the first dose;
● 1 tablet 48 hours after the first dose.

If sexual activity continues over the following days:

● take 1 tablet every 24 hours while sexual activity continues;
● after the last sexual encounter, continue taking 1 tablet daily for the next 2 days.

The “2+1+1” regimen is not suitable for everyone, so you should discuss whether this option is appropriate for you with a healthcare professional.

Injectable PrEP

Injectable PrEP is a long-acting form of HIV prevention that provides protection without the need to take tablets every day.

Injectable PrEP uses a long-acting medication administered by intramuscular injection.

Injection schedule:

● first injection;
● second injection 4 weeks later;
● thereafter, 1 injection every 8 weeks.

Injectable PrEP may be a convenient option for people who find it difficult to take tablets regularly or who prefer a long-acting method of HIV prevention.

The form and PrEP regimen that is right for you should be determined together with a healthcare professional. Regular HIV testing is required before starting and while using PrEP.

A doctor will not prescribe PrEP if the patient has:

● a positive HIV status;
● symptoms or signs of acute HIV infection;
● had recent exposure to a person living with HIV;
● an estimated creatinine clearance below 60 mL/min;
● hepatitis B virus (HBV) infection (for the on-demand PrEP regimen);
● an allergy or contraindication to any component of the PrEP regimen.

Please note: allergies to tenofovir and emtricitabine are rare.

The oral PrEP regimen uses two medications that work together to enhance protection. For PrEP to be effective, it should be taken as prescribed by a healthcare professional.

The protective effect of oral PrEP is achieved:

● with daily PrEP — after taking 7 doses;

● with on-demand PrEP (the “2+1+1” regimen) — after taking 2 tablets 2–24 hours before sexual activity.

Injectable PrEP provides long-lasting protection against HIV without the need to take tablets every day. It uses a long-acting medication administered by intramuscular injection.

● the first injection is given when PrEP is initiated;

● the second injection is given 4 weeks later;

● subsequent injections are given every 8 weeks.

It is important to follow the injection schedule recommended by a healthcare professional to maintain an adequate level of the medication and continuous protection against HIV.

If a potential exposure to HIV occurs before PrEP has reached its full protective effect, contact a healthcare professional as soon as possible for a risk assessment and to determine whether post-exposure prophylaxis (PEP) is needed. PEP should be started as soon as possible after a potential HIV exposure, but no later than 72 hours afterward.

Daily oral PrEP reduces the risk of acquiring HIV by approximately 99% when taken correctly and consistently. If the dosing schedule is not followed, the level of protection may decrease.

According to research findings, the effectiveness of oral PrEP depends on how consistently the medication is taken:

● for people who take 7 tablets per week — approximately 99%;

● for people who take 4 tablets per week — approximately 96%;

● for people who take 2 tablets per week — approximately 76%.

On-demand PrEP (the “2+1+1” regimen) is also a highly effective method of HIV prevention when the dosing schedule is followed correctly. Research shows that proper use of on-demand PrEP can reduce the risk of acquiring HIV by approximately 97%.

Injectable PrEP is a highly effective method of HIV prevention that does not require taking tablets every day. Long-acting cabotegravir (CAB-LA) is used for injectable PrEP.

In large clinical trials, CAB-LA demonstrated even greater effectiveness compared with daily oral PrEP. Across two key studies, the use of injectable CAB-LA was associated with a 79% lower risk of acquiring HIV compared with oral PrEP, largely because it may be easier to adhere to a regular injection schedule than to take tablets every day.

To maintain a high level of protection, it is important to receive each injection on time according to the recommended schedule.

Regardless of the form of PrEP you choose, maximum protection depends on correctly following the dosing regimen or injection schedule.

PrEP is generally compatible with most medications, hormonal contraceptives, and alcohol. Drinking alcohol does not in itself reduce the protective effect of PrEP, provided that the recommended dosing regimen or injection schedule is followed.

Oral PrEP can be safely used with hormonal contraceptives and most other medications. However, some medications, particularly those that may affect kidney function, require additional consideration and consultation with a healthcare professional.

Injectable PrEP is also compatible with alcohol and hormonal contraceptives. However, injectable cabotegravir (CAB-LA) may interact with certain medications, including some anticonvulsants and medications used to treat tuberculosis.

If you regularly take any medications, vitamins, or supplements, or are receiving treatment for other health conditions, inform your healthcare professional before starting PrEP. This will help determine the safest and most effective HIV prevention regimen for you.

Post-exposure prophylaxis (PEP) is a 28-day course consisting of three antiretroviral medications. It must be started within the first 72 hours after a potential exposure to HIV. PEP is intended for emergency situations involving exposure to body fluids that may contain a high concentration of HIV.

Such unexpected situations may occur:

● during professional activities — for example, healthcare workers may be exposed while providing care to patients;

● during accidental non-occupational exposure — for example, sexual contact during which a condom slips off or breaks in a serodifferent couple (where one partner is living with HIV), sexual assault, a single episode of injecting drug use, etc.

The effectiveness of PEP, when started promptly and taken correctly without missing doses, is estimated at 79–89%.

Important: PEP is not intended for regular use.

If, after completing PEP, the HIV test result remains negative but there is still an ongoing risk of acquiring HIV, PrEP can be started. There should be no gap between completing PEP and starting PrEP.

If a person has a recurring or ongoing increased risk of acquiring HIV, pre-exposure prophylaxis (PrEP) may be a more appropriate option for additional protection.

Condoms are recommended even while using PrEP. When used correctly, PrEP is a highly effective method of HIV prevention; however, it does not protect against other sexually transmitted infections (STIs) or unintended pregnancy.

Condoms provide additional protection against HIV and help reduce the risk of acquiring syphilis, gonorrhea, chlamydia, and other STIs.

PrEP + condoms provide a comprehensive approach to protecting your sexual health.

Consistency is one of the key factors in ensuring the effectiveness of PrEP. With daily oral PrEP, it is usually easier to establish a routine because the medication is taken every day at approximately the same time. On-demand PrEP (“2+1+1”) is taken according to the timing of sexual activity, so it is important to follow the dosing schedule carefully.

If you choose injectable PrEP, you do not need to remember to take tablets every day. However, it is important to receive each injection on time according to the schedule recommended by your healthcare professional.

What can help you stay adherent to your PrEP regimen:

● learn more about PrEP — understanding how it works and its benefits can help you stay committed to prevention;

● find your personal motivation — protecting your health, relationships, career, travel, sports, family planning, or simply feeling confident about your protection;

● choose a convenient time for taking daily oral PrEP;

● set reminders on your phone for taking your tablets or receiving your next injection;

● use a 7-day pill organizer;

● make taking your tablet part of your daily routine — for example, when brushing your teeth, having breakfast, or following your evening routine;

● keep your tablets in a convenient and accessible place while following the medication’s storage instructions;

● seek support from your partner, family, friends, social workers, or healthcare professionals;

● stay in regular contact with your healthcare professional and complete the recommended check-ups and tests.

For injectable PrEP, it is particularly important not to miss scheduled appointments. Add the date of your next injection to your calendar in advance and set a reminder. If you miss an injection or cannot receive it on time, contact your healthcare professional to determine the appropriate next steps for HIV prevention.

Alcohol or other psychoactive substances may increase the likelihood of forgetting to take a tablet or missing a scheduled injection appointment. Set reminders in advance and follow your chosen PrEP regimen as closely as possible.