Providers

Currently in South Africa, PrEP is being provided through a limited number of service delivery sites. Use the PrEP finder search for the nearest PrEP clinic.

If a client becomes HIV positive while on PrEP, will they be resistant to ARVs?

Drug Resistance Fears, Providers

If your client is on PrEP and they still get HIV their health care provider will do some tests to determine why they seroconverted. It does not necessarily mean that they will be resistant to ARVs (ex: window period, low adherence, infected with TDF resistant virus, etc).

NO EXCUSES! PrEP should be used with other HIV prevention methods.

PrEP and Pregnancy, Providers

PrEP means taking a pill every day and going for regular HIV testing, NO EXCUSES!

PrEP should be used with other HIV prevention methods.

What must your client do if she wants to become pregnant while taking PrEP?

PrEP and Pregnancy, Providers

She must inform her clinician and together they will discuss how to proceed.

When and how can your client stop taking PrEP?

PrEP Adherence, Providers

If your client decides that they no longer wish to take PrEP, they should discuss stopping with a healthcare provider. They will get information for how long after they should continue to make sure they are properly protected.

What happens if your client misses a PrEP pill?

PrEP Adherence, Providers

If your client misses a pill, they should take it as soon as they remember, and continue to take it daily as before.

PrEP requires strict adherence to daily medication and regular HIV testing. Where possible, it should be used together with other HIV prevention methods.

If it is used properly, PrEP will play a role in helping to reduce the number of new HIV infections in South Africa.

Discussing adherence

Providers, Supportive Counselling Messages

“Pill taking isn’t easy and takes some practice, especially if you aren’t used to taking pills.”

“It’s okay to not be perfect at taking your pills; it takes time. But remember in order for PrEP to work, you have to take your pills regularly.”

“I’m here to help by working with you to figure out a way to make taking your pills easier, so that you get the most protection you can.”

Combination prevention

Providers, Supportive Counselling Messages

“PrEP is a great way to prevent HIV, but it doesn’t protect against other STIs or prevent pregnancy.”

“Using condoms and PrEP together will give you the best level of protection from both HIV and other STIs.”

Considering PrEP

Providers, Supportive Counselling Messages

“PrEP is a great way to prevent HIV, but it isn’t for everyone.”

“Taking a pill every day for ongoing protection from HIV might not be for everybody, but PrEP is an excellent and much-needed extra prevention method for people at high risk of getting HIV.”

“The use of PrEP is supported by South African medical experts, the South African government, and many international experts.”

“You’ve decided to use PrEP as a way to protect yourself and that’s great.”

“If you start PrEP, you do not have to take it for the rest of your life.”

Examining risk profile

Providers, Supportive Counselling Messages

“Let’s look at your risk and options to prevent HIV.”

“Let’s talk about how PrEP fits into your risk reduction efforts.”

Remember! Be honest, direct and non-confrontational

Adherence Counselling, Providers

Supporting pill-taking should be honest, direct and non-confrontational.

Steps to follow:

Assess how pill taking is going for PrEP client
Positively affirm client to support provider/client relationship
Identify a motivator to support effective pill taking
Provide PrEP education regarding effective use and effectiveness of PrEP
Identify barriers to effective use
Provide realistic strategies to address barriers
Discuss use of other HIV prevention measures that are relevant to situation
Ensure client leaves with realistic and achievable plan to increase or sustain use

Adherence is critical to providing protection against HIV

Adherence Counselling, Providers

Adherence means taking the PrEP pill every day.

Suggest methods to remind the client to take the pill every day.

For example:

Take the pill at the same time every day
Incorporate it into your daily activities, like part of your morning routine or when a favourite TV show comes on
Set a phone alarm
Use daily pillboxes

Daily PrEP can be taken with alcohol, drugs or contraception. It does not react negatively with any normal day to day activity.

Discuss what to do if a pill is missed – take it as soon as client remembers.

Checklist: Follow-up Counselling

Counselling Checklists, Providers

Follow-up sessions will most likely be brief. It is critical to review adherence during these discussions and re-evaluate the client’s risk profile if he or she has experienced lifestyle changes. Please ensure you use your organisation’s available counselling tools for each of these topics.

Re-assess the client’s risk profile

Discuss any lifestyle changes that may affect the suitability of PrEP use.

Combination prevention

Touch base with the client’s sexual health plan and make sure they have access to other prevention resources, as appropriate.

STIs

PrEP does not protect against STIs. Regular testing for STIs is encouraged, regardless of PrEP use. IMPORTANT: If your client presents with an STI, they will need additional counselling.

Contraception / Fertility goals

PrEP is not a contraceptive. PrEP is safe to use with all contraceptive methods. Consult with a physician to provide guidance on how to proceed if the client becomes pregnant.

Adherence (daily)*

For PrEP to be effective, the pill must be taken every day. Adherence counselling is critical for full HIV protection. *More detail is provided in the Adherence section that follows.

Side effects

Touch base about the client’s experience with side effects.

REMEMBER: If side effects are serious, please involve a doctor with your client’s care.

Intimate partner violence (IPV)

People who have abusive or controlling partners may find it more difficult to take care of their sexual health and to adhere to PrEP. Ask about the client’s relationships, and for clients experiencing abuse, provide counselling and referrals, when possible.

Talking to your partner, family, friends, etc.

Deciding whether to tell anyone about your PrEP use is a completely personal decision. Some people find it helpful to tell friends or family for support and to provide reminders to take the pill daily. Discuss with the client whether and how they would like to discuss PrEP with loved ones and how to overcome any potential barriers to gaining their support.

Visit schedule

Explain the visit schedule for PrEP use. The client must return for follow-up visits at the first month, and then every three months. They must also return to the clinic monthly to pick up their pills.

Checklist: Counselling prior to PrEP initiation

Counselling Checklists, Providers

This is a list of important topics to discuss with the client when explaining PrEP for the first time and deciding whether it might be right for him or her. It is not comprehensive. Please ensure you use your organisation’s available counselling tools for each of these topics.

What to discuss:

Assess the client’s risk profile

How to discuss it:

Develop a clear picture of the client’s risk profile and lifestyle; make sure they understand how their lifestyle impacts their risk profile. IMPORTANT: use your organisation’s risk assessment tools.

What to discuss:

Combination prevention

How to discuss it:

Taken daily, PrEP is an additional prevention option. It should be used in combination with other prevention tools, like condoms, PEP, healthy lifestyles, treatment for STIs, male medical circumcision, and ART for partners living with HIV. REMEMBER: counselling should highlight that ideally PrEP should be used with condoms.

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Counselling should be:

Counselling Guidelines, Providers

Sensitive, inclusive, and non-judgmental
Recognize that behaviour change is difficult and human beings are not perfect
Presented as a personal choice
Counselling should support the client in making a personal choice based on their needs and desires.
Problem solve and foster motivation
Offer choices and tangible solutions; identify small wins and achievable next steps in reducing risk.
Client-driven and based on their needs, resources, and preferences
Counselling should be interactive and tailored to the client’s specific needs and lifestyle.
Brief
10-15 minute check-ins about experience with PrEP and sexual health protection plans are most effective; longer (~30 minute) sessions may be necessary at the first PrEP consultation or if specific issues arise.