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editorial
. 2018 Jul 1;4(3):143–159.
A. High risk – recommend prescribing daily PrEP if the patient acknowledges
Having had any of the following in the last 3 months
  • At least one episode of condomless anal intercourse (CLAI) with a regular HIV+ partner (not on treatment and/or detectable viral load)

  • At least one episode of receptive CLAI with any casual HIV+ male partner or a male partner of unknown status

  • Rectal gonorrhoea, rectal chlamydia or infectious syphilis diagnosis (during the last 3 months or at screening for PrEP)

  • Methamphetamine use, which may increase the risk of HIV acquisition

AND Being likely to have in the next 3 months (indicating sustained risk)
  • Multiple episodes of CLAI with or without sharing intravenous drug equipment

B. Medium risk – consider prescribing daily PrEP, based on a case-by-case approach if discussion reveals
Having had any of the following in the last 3 months
  • More than one episode of anal intercourse when proper condom use was not achieved (e.g. condom slipped off or broke) where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load

  • (If patient uncircumcised) more than one episode of insertive CLAI where the serostatus of partner was not known, or was HIV+ and not on treatment or with a detectable viral load

AND Being likely to have in the next 3 months (indicating sustained risk)
  • Multiple episodes of CLAI with or without sharing intravenous drug equipment

Case-by-case approach
Based on a complete sexual and alcohol and other drug-using history and the personal circumstances of the patient, if the clinician is of the opinion that the patient is likely to be at high risk of HIV, then PrEP prescription may be considered despite the absence of reported high- or medium-risk factors above.