Strict dosage adherence urged in Event Driven PrEP

LINEO MABEKEBEKE

MASERU – There is need for strict adherence to the dosage schedule of Event Driven PrEP, HIV testing service lay counsellor and peer educator Tello Hlao has warned. Hlao says adherence is key to reduction of risks of transmission. Event Driven PrEP, also known as PrEP on-demand, is a strategy for HIV prevention that involves taking Pre-Exposure Prophylaxis (PrEP) medication before and after engaging in high-risk activities, rather than taking it daily.

It targets individuals who may not engage in high-risk behaviors regularly but may have occasional instances where they are at increased risk of HIV transmission, such as during unprotected sex or injection drug use. Hlao says Event Driven PrEP was put in use as an alternative dosing strategy for individuals who may find daily PrEP adherence challenging, or for those who engage in sporadic high-risk behaviors and may not require daily protection.

She says Event Driven PrEP differs from daily PrEP in dosing schedule.” Daily PrEP involves taking a pill every day regardless of sexual activity, whereas Event Driven PrEP involves taking PrEP pills before and after anticipated high-risk activities,” she added.

This type of PrEP is typically available through healthcare providers or clinics that offer HIV prevention services, and Hlao highlighted that it may require a prescription from a healthcare provider.

Since its introduction and launch the country around 2022, she says Event Driven PrEP shown to effectively reduce the risk of HIV transmission when taken as prescribed around the time of high-risk activities.

She added: “For the individuals it was initiated for, adherence to Event Driven PrEP may vary. Some individuals may find it easier to adhere to this dosing strategy if they only engage in occasional high-risk behaviors, while others may struggle with adherence due to the need to plan doses around specific events.”

Although there are challenges with its use, she also highlighted that there are successes in the use of Event Driven PrEP, with studies demonstrating its effectiveness in reducing the risk of HIV transmission among individuals who adhere to the prescribed dosing schedule.

“These studies were not conducted in Lesotho but rather abroad before the event driven PrEP was given a green light to be used,” she explained.

According to World Health Organisation (WHO), daily oral PrEP is still recommended for all people at risk of HIV, including men who have sex with men, when Event Driven-PrEP could be considered as an alternative to daily PrEP.

WHO says since youth may require more active support for continuation and in understanding how to safely start and stop PrEP, along with how and when to shift back and forth between daily dosing and Event DrivenPrEP, some may find a daily oral schedule easier to follow.

“For men who have sex with men oral daily PrEP and Event Driven-PrEP can be offered as options, and the choice can be based on a person’s circumstances and preferences, as determined by what best fits their lifestyle, including the frequency and predictability of sex and whether sex is anticipated,”

WHO recognizes the urgent need for health care systems to be more inclusive of transgender populations, from pharmacology to implementation science.