Bath Avenue Medical Centre

As PrEP can only be used if you are HIV-negative, you will need to have a few tests before you start PrEP:

• A (4th generation) HIV blood test.

• A test for hepatitis B (because PrEP is active against both HIV and hepatitis B).

• A test for hepatitis C and Syphilis.

• Tests for Chlamydia and Gonorrhoea.

• A kidney function blood test (because a small number of people taking PrEP have developed reduced kidney function).

• A pregnancy test (if applicable).

• It is also a good time to get vaccinated against hepatitis A and B and HPV or boost previous vaccinations if necessary.

• If HIV PEP is required, arrangements will be made to start PrEP at the end of the course of PEP.

PrEP is available in pharmacies nationwide. If you encounter a pharmacy that does not have PrEP, they can order it and it will usually be delivered the next day, and sometimes on the same day, depending on the time the order is placed.

PrEP is a tablet that you take by mouth. There are different dosing regimens but the best and most effectively proven regimen is taking one pill a day, every day. Event Based Dosing is available as an option also. Talk to the Doctor or Nurse at Bath Avenue Medical Centre about what dosing regimen will work best for you.

When you start taking PrEP you also have to get the drug levels high enough in your body to protect you:

• for anal sex, Ideally, you will need to take at least two tablets 24 hours before sex, and then continue to take one every day.

• for vaginal sex, Ideally, you will need to take PrEP for 7 days before sex and then continue to take one every day.

If you have questions about your options or your preferred choice, get in touch with Bath Avenue Medical Centre at 01 6686990.

• Initial Visit €150 (which includes blood tests, a Doctor’scheckup, and comprehensive personal health (STI) laboratory tests). This process is required by the HSE for Bath Avenue Medical Centre to be allowed to provide the PrEP prescription to your chosen Pharmacy, so you can collect your medication free of charge.

• Hep A vaccination and Hep B vaccination €55 (Per injection)

• HPV Vaccination course (Gardasil 9 course of 2 vaccinations) 1st Vaccine €240.00, 2nd Vaccine €240.00

• Bath Avenue Medical Centre participates in the HSE National Condom Distribution Scheme. Free condoms and lube are available when you visit for a PrEPcheckup.

Once you have started PrEP, Ideally, you will need to see the Doctor for a check-up every 3 months. This is to check for HIV and STIs and to monitor your kidney function with blood tests. Although side effects are rare with PrEP, the clinic monitoring and checkups will help to identify and remedy any potential problems at an early stage.

Every 3 months you should have the following tests:

• A ‘4th generation’ HIV blood test.

• Screening testsfor other STIs.

• A blood test to check your kidney function (this will happen at your first 3-month appointment after starting PrEP and thereafter as recommended by your clinic).

Every 12 months: you should have a hepatitis C test. (This may need to be done more frequently).

If you miss one or two pills, don’t stop. Just continue once you remember. There is likely to be enough medicine in your body to protect you against HIV.

If you are missing several doses a week, we would be concerned that you might not be protected against HIV transmission if you came in contact with the virus. You might need Post Exposure Prophylaxis (PEP) in this scenario. You should talk to the Doctor for advice if this issue affects you. You can access PEP up to 72 hours after a potential exposure to HIV. PEP is normally prescribed and monitored through the hospital Emergency Department. We can help you find out more about how to access it if needed.

If you are taking PrEP, try to pick a regular time each day to take your tablet. You don’t have to take the tablet at the exact same time every day, but perhaps you could consider linking your daily tablet to a daily task such as having your breakfast or brushing your teeth, it could help you remember.

Yes you can. It is always best to discuss your decision to stop with your Doctor. Before you stop please consider this advice:

• If you’ve been taking PrEP to stop HIV through anal sex, don’t stop until 48 hours after the last time you had sex.

• If you’ve been taking PREP to stop HIV through vaginal sex, don’t stop taking it until 7 days after the last time you had sex.

• If you’re at risk of HIV through injecting or slamming drugs, don’t stop taking it until 7 days after the last risk for HIV.

Like all medicines, PrEP can cause some Side Effects. Side Effects can include mild nausea, diarrhoea, bloating and headaches. These issues effect fewer than 1 in 10. People taking PrEP who experience these side effects report that they normally stop within the first month. Most people taking PrEP do not report any major side effects. Occasionally PrEP can cause more serious side effects.

• Kidney function: Taking PrEP can affect your kidneys. This is is why monitoring your kidney function with regular blood tests is so important.

• Bone density: PrEP can reduce bone density by between 1% and 2%, causing slight weakening of the bones. This does not cause significant problems for the majority of people. This issue is reversed after PrEP treatment is stopped.

• Interactions with other medications: Tenofovir and Emtricitabine do not interact with many other medicines. One important consideration is the potential interaction between Tenofovir and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). This is especially true with Diclofenac, which when taken together with Tenofovir can cause kidney problems. Other medicines in this class include Ibuprofen and Naproxen. Avoid using these medicines if you are taking PrEP, or let your GP know if you need to take them.

• For transgender people taking PrEP, there is no reason to expect PrEP will change the effectiveness of hormone therapy. There is some evidence that feminizing hormones can affect the levels of PrEP in your system. It is advised that transgender women who are using hormone therapy use daily PrEP only, and not event based dosing.

If you do not meet the criteria for free PrEP you can decide to pay for PrEP. You can access PrEP through community pharmacies with a Doctor’s Prescription.