Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP)
Two important methods for preventing HIV
using medication are pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP involves
administering antiretroviral medications to HIV-negative individuals to prevent infection. PrEP is taken before
having a potential HIV exposure to reduce the risk of infection. It can be taken on a regular basis as directed
by a medical provider or before a sexual encounter and afterwards to minimize risk.
Access to comprehensive PrEP is a key component of the National HIV/AIDS Strategy for the United States. As of
2021, there are two types of anti-HIV drugs that have been approved as PrEP tablet options depending on what may
work best for an individual. The two types of tablets that have been approved as PrEP are Truvada® and Descovy®.
In 2012, the U.S. Food and Drug Administration (FDA) approved Truvada®
as the first drug to reduce the risk of transmitting HIV. Then in 2019, the FDA approved the use of
Descovy® in male adults and adolescents but not for females, due to a lack of studies in this population. Both
tablets include a drug called
emtricitabine. Truvada also includes the drug tenofovir disoproxil fumarate, while Descovy includes the
drug tenofovir alafenamide. Additional drugs are currently being studied for PrEP but have not yet been approved
by the FDA. When taken as prescribed, PrEP is highly effective in reducing the risk of HIV infection and is even
more effective when used in conjunction with condoms and other prevention strategies.
Estimates from the Centers for Disease Control and Prevention (CDC) suggest that many people at high risk for HIV are not taking
PrEP. In an effort to increase the number of people who could use PrEP to reduce risk of HIV but may
face various barriers to accessing the medication, in 2019, the U.S. Department of Health and Human Services
started a campaign called Ready,
Set, PrEP. The program provides free PrEP to people living all over the country including tribal lands
When people know they have been exposed to HIV, post-exposure
prophylaxis (PEP), or antiretroviral medication, has also been shown to reduce the risk of HIV. PEP may
be used in non-occupational settings when a person has an unprotected sexual encounter with an HIV-positive
person or may be used in occupational settings, such as when a healthcare worker is stuck with a needle used on
an HIV-positive person. The PEP regimen must be initiated within 72 hours after possible exposure to HIV, though
beginning the medication sooner is more effective in preventing HIV.
Examples of Rural Programs Using HIV Medications to Prevent Transmission:
Health Services Center is a community-based organization in Alabama
that offers PrEP services as a
preventive method for those at high risk of HIV. Along with providing PrEP medications free of charge, the
Health Services Center also continually monitors people on a PrEP regimen, educates people about important
HIV prevention strategies, and tests for other sexually transmitted infections prior to starting a person on
The Colorado Health Network (CHN)
utilized a funding opportunity offered through the Colorado Department of Public Health and Environment
Public Health Improvement Plan, which aims to improve access to PrEP drugs for high-risk individuals. CHN
used these funds to hire additional clinicians and office staff dedicated to work solely with PrEP patients.
The Dakotas AIDS Education and Training Center
(DAETC) works with 10 community health centers in the Dakotas to educate healthcare providers about HIV
treatment and prevention methods for their largely rural and tribal populations. Oklahoma is one of seven
states identified to receive extra federal resources to target prevention under the Ending the HIV Epidemic
initiative, as it is a rural state with high rates of HIV transmission. As part of the HIV prevention
strategy in Oklahoma, Rapid Start and PrEP programs are available at all county health departments
and through additional community organizations and health care providers. Rapid Start programs work to
identify new HIV cases quickly through testing and to connect people with antiretroviral treatment as soon
as they are diagnosed.
Considerations for Implementation
Pre-exposure prophylaxis (PrEP) is an increasingly important strategy being recommended for the prevention of
HIV. Cultural barriers, a lack of community knowledge about PrEP, and access to care barriers all are factors
that need to be considered when implementing a program that will utilize PrEP. PrEP is a medication that needs
to be prescribed by a healthcare provider in a clinical setting, which can also be a challenge in some
Administering post-exposure prophylaxis (PEP) within the 72-hour time period is a key part of the HIV prevention
strategy for this medication. As such, it is important that people are aware of the limited time period
available to use PEP.
Some states may have developed strategies and programs to help subsidize or fully cover the cost of PrEP and PEP
medications. For example, New York has implemented a plan to help reimburse
individuals who qualify for these medications. Many insurance plans also fully cover the cost of these
drugs; however, providers should investigate what each patient's insurance will cover prior to initiating these
regimens since these medications can be costly and some insurance plans have limitations. In cases where a
patient's health insurance does not cover the full cost, the manufacturers of the PEP and PrEP drugs also have
their own medication assistance program.
Resources to Learn More
HIV Basics: PrEP
Provides information and clinical recommendations about PrEP for the general public. Covers several PrEP topics
by answering common questions and offers a video discussing the benefits of PrEP.
Organization(s): Centers for Disease Control and Prevention (CDC)
Preexposure Prophylaxis for the
Prevention of HIV Infection in the United States – 2017 Update: A Clinical Practice Guideline
Presents information on the use of antiretroviral preexposure prophylaxis (PrEP) to reduce the risk of HIV
infection in adults. Discusses the risks and benefits, Food and Drug Administration (FDA) recommendations for
PrEP, follow-up assessments for patients taking PrEP, other prevention methods to be used along with PrEP, and
clinical trials that established safety and efficacy of the PrEP regime.
Organization(s): Centers for Disease Control and Prevention (CDC)
PrEP and Local
Health Departments Educational Series
Educational series aimed at increasing knowledge of local health departments and building awareness of how to
use and implement PrEP (Pre-Exposure Prophylaxis) for HIV prevention. Discusses the role that local health
departments can play in delivering and supporting PrEP for HIV prevention.
Organization(s): National Association of County and City Health Officials (NACCHO)
PrEParing Latinos for HIV
Features information about the impact of the HIV epidemic on the Latino community. Describes how PrEP can be
used to prevent new infections and the challenges faced in accessing treatment in rural communities.
Author(s): Zaldivar, R.
Organization(s): AIDS Community Research Initiative of America
Have the Tools to End HIV: Benefits, Barriers, and Solutions to Expanded Utilization of Pre-exposure
Prophylaxis (PrEP) in the US Deep South
Describes the high prevalence of HIV/AIDS in the Southeastern portion of the U.S. Highlights the benefits of
PrEP as an effective HIV prevention tool. Discusses the barriers to the usage of PrEP among vulnerable
populations in the region and the potential methods to overcome the PrEP challenges.
Organization(s): Southern HIV/AIDS Strategy Initiative
Non-Occupational Post-Exposure Prophylaxis (nPEP) Toolkit
Compiles materials and resources for providers to use in clinical settings supporting the use of post-exposure
prophylaxis after potential HIV exposure.
Author(s): Southerly, J., Guido, A.A., Morrison, D., et al.
Organization(s): AIDS Education & Training Center (AETC) Program National Coordinating Resource Center