In February 2016, Health Canada approved the daily use of the antiretroviral drug Truvada, in combination with safer sex practices, to reduce the risk of the sexual transmission of HIV. The approval is an important step towards the wider use of pre-exposure prophylaxis, or PrEP, for HIV prevention in Canada.
This article presents resources and tools from Canada and other countries that can help service providers inform themselves and their clients about PrEP. While all these resources agree that the consistent and correct use of oral PrEP is a highly effective strategy to reduce the risk of HIV transmission, there are some slight differences in messaging due to differences in interpretation of the science or due to timing of the resource.
Access to Truvada for PrEP varies from country to country, giving us resources with different perspectives on the promotion and use of PrEP to learn from. Varying access to PrEP also means some information from other countries may not be applicable to us here in Canada, for example how to access PrEP and drug coverage. For more information on PrEP access in different countries, visit the PrEP Watch website.
Learning PrEP Basics
If the idea of PrEP is still new to you, these resources can help you understand the basics. They range from brief introductions to longer explanations.
- Oral pre-exposure prophylaxis (PrEP) -- CATIE's fact sheet on oral PrEP reviews the concept of PrEP, the evidence around safety and effectiveness, and access to PrEP.
- What is PrEP? -- A short and simple video from the United States that uses animation to illustrate how Truvada works in the body to prevent HIV infection.
- PrEP -- A briefing paper from NAM in the United Kingdom that reviews PrEP as a prevention strategy, including results from key PrEP studies.
- Oral pre-exposure prophylaxis: Questions and answers -- This introduction to PrEP from UNAIDS covers PrEP basics, eligibility, use and implementation.
Sharing Information on PrEP With Clients
These client resources can help your clients learn more about PrEP. Information is presented in different formats including videos, web pages, fact sheets, and booklets.
- Pre-exposure prophylaxis (PrEP) -- A brief video from the Clinique médicale l'Actuel in Quebec that reviews different aspects of PrEP including how it can be used to prevent HIV infection, the side effects of taking Truvada for PrEP and the difference between PrEP and post-exposure prophylaxis (PEP). (The video was made before the results of the IPERGAY intermittent PrEP study were published.)
- PrEP -- Online PrEP information from the AIDS Committee of Toronto (ACT) that can be used to learn more about PrEP and its potential role in a person's HIV prevention strategy.
- PrEP -- Pre-Exposure Prophylaxis -- Introductory information on PrEP presented in question and answer format from the organization REZO in Quebec.
- Pre-exposure prophylaxis (PrEP) fact sheet -- This PrEP fact sheet from the Health Initiative for Men (HiM) in British Columbia covers the use of and access to Truvada for PrEP. (Published in 2015, the fact sheet does not reflect that PrEP is now approved in Canada.)
Sharing Information on PrEP With Clients From Specific Populations
These additional client resources focus more closely on PrEP use by specific populations including gay men, women and trans women.
Supporting Clients to Decide if PrEP Is Right for Them
These client resources focus on helping people decide if PrEP is right for them, including how to talk to their doctors about PrEP.
- Are you ready for PrEP? -- This short video from the US Centers for Disease Control and Prevention (CDC) reviews things to consider when deciding whether to start PrEP and suggests questions about PrEP to ask a doctor during a medical appointment. The PrEP decision making considerations are also summarized in an infographic.
- Is PrEP right for me? -- From The Stigma Project in the United States, this interactive online tool helps people determine if PrEP is a good prevention strategy for them. The tool guides you through a series of questions and makes a recommendation based on your answers following PrEP guidelines from the CDC.
- Take charge: talk to your provider about PrEP -- A brochure from the CDC that provides checklists of activities to do before, during and after a discussion about PrEP with a doctor. It also provides a list of questions about PrEP a client may want to ask their doctor.
- PrEP and working through a difficult doctor visit -- This booklet from the American organization Project Inform reviews arguments a doctor may make against prescribing PrEP and suggests responses a client can use to counter them during a medical appointment.
Learning How to Address PrEP in Your Service Delivery
These resources combine explanations of PrEP with practical tips on how to implement and address PrEP during program and service delivery in community and clinical settings.
- CATIE statement on the use of pre-exposure prophylaxis (PrEP) to prevent the sexual transmission of HIV -- CATIE's statement summarizes the evidence on Truvada as PrEP, provides recommendations to service providers on how to integrate PrEP into their practice and lists additional tools and resources.
- Avis intérimaire sur la prophylaxie préexposition au virus de l'immunodéficience humaine -- Written before the approval of Truvada for PrEP in Canada, this document from the Ministry of Health and Social Services of Quebec reviews research on the effectiveness of PrEP and considers the potential role of PrEP in HIV prevention and health care services. (French only)
- Oral pre-exposure prophylaxis: putting a new choice in context -- A resource from the WHO, UNAIDS and AVAC which reviews the role of PrEP within HIV prevention, its benefits and issues to consider, and strategies for implementing PrEP at the program and national levels.
- PrEP kit: A resource guide about pre-exposure prophylaxis -- Produced by the American organization AIDS United, this resource provides guidance to people working in community-based organizations. It includes questions a service provider can ask to help determine if their client is ready for PrEP, and tips and tools for supporting a client who is starting PrEP.
Learning About PrEP Management in Clinical Settings
These guiding documents outline how PrEP can be managed in clinical settings. They include recommendations on who should be using PrEP and the prescription, monitoring and discontinuation of PrEP.
- Guidance for the use of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia -- Guidance from the British Columbia Centre for Excellence in HIV/AIDS developed before the approval of Truvada for PrEP in Canada that provides considerations for PrEP delivery in clinical settings.
- Pre-exposure prophylaxis for the prevention of HIV infection in the United States -- 2014: A clinical practice guideline -- PrEP guidelines from the US Centers for Disease Control and Prevention (CDC). The guidelines are complemented by a clinical providers' supplement with additional tools such as information sheets for patients and providers and client counselling guides.
While these resources are a great start for learning about and implementing PrEP in your programming, it's also important to remember that PrEP is still developing as an HIV prevention strategy and PrEP research and advocacy are ongoing. For the latest PrEP developments, keep up-to-date with the CATIE or PrEP Watch websites among other sources.
Erica Lee is the Information and Evaluation Specialist at CATIE. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).