Postexposure prophylaxis-in-pocket (PIP) is an HIV prevention modality for people with infrequent and often unanticipated HIV exposures (e.g., 0–4 per yr)1,2

Clinicians should identify eligible people proactively, provide them with a 28-day supply of guideline-approved postexposure prophylaxis (PEP) regimens before an exposure (Box 1),4 and advise them to fill the prescription and have the medications available.

Box 1: Examples of postexposure prophylaxis-in-pocket regimens

One BIC/FTC/TAF tablet daily, taken orally for 28 days.3

One TDF/FTC tablet daily and dolutegravir (50 mg/d), both taken orally for 28 days.4,*

One TDF/FTC tablet daily and raltegravir (400 mg, twice daily), both taken orally for 28 days.4,*

Note: BIC/FTC/TAF = bictegravir/emtricitabile/tenofovir alfenamide 50/200/25 mg per tablet, TDF/FTC = tenofovir disoproxil fumarate/emtricitabine 300/200 mg per tablet.

↵* Preferred regimen in those who are pregnant or of childbearing age.

After a potential HIV exposure, people should self-initiate PIP as soon as possible and within a 72-hour window4

After self-initiating PIP, patients should be seen within a week of initiation for baseline testing for HIV and sexually transmitted infections and to ensure that starting PIP was appropriate.1 They should be seen for follow-up HIV testing in 3 months.

Use of PIP has been successful in people with a broad range of risk factors for HIV transmission

People who may have a higher risk of nonconsensual sex (e.g., sex workers, survivors of domestic assault), people with limited access to urgent care, people who mostly use condoms but infrequently do not, people who inject drugs and infrequently share paraphernalia, or people who may have an HIV exposure while travelling can benefit from PIP.1,2

Postexposure prophylaxis-in-pocket fills a gap in HIV prevention between traditional PEP and pre-exposure prophylaxis (PrEP)

Uptake of PrEP has been low among women and people who inject drugs.5 Access to PEP is hindered by knowledge gaps, stigma, and finances, influencing people’s ability to urgently obtain care, medications, or follow-up.1,5 Many of these issues can be alleviated by advance prescription and procurement of PIP, which allows for referral to social work or community services to navigate assistance in acquiring medications.1,2

People may fluidly transition between HIV prevention modalities based on risk factors under the guidance of a health care provider2

Patients should complete their PIP course before initiating PrEP; alternatively, patients may initiate PIP following the discontinuation of PrEP.2

Footnotes

Competing interests: Maxime Billick reports consulting fees from the Ontario Dermatologic Nurses’ Association. Isaac Bogoch reports consulting fees from the Weapons Threat Reduction Program, Global Affairs Canada. No other competing interests were declared.

This article has been peer reviewed.

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