Guidance to PrEP prescribers regarding the delisting of Truvada from the PBS

 

Prepared by: The ASHM Antiretroviral (ARV) Guidelines Committee, A/Prof. Edwina Wright, and Kate Bath.

 

UPDATED ON: 21 May 2020

 

 

Disclaimer:  This ASHM document is designed to provide available, relevant information to clinicians and other healthcare providers to optimise the health and wellbeing of people living with HIV (PLWHIV) during the COVID-19 pandemic. The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence, but will be revised to include relevant future systematic review findings of the National COVID-19 Clinical Evidence Taskforce(1) and other relevant information. 

 

 

Reminder: From 1 April 2020 Truvada® (emtricitabine/tenofovir disoproxil fumarate) for HIV treatment and for pre-exposure prophylaxis (PrEP) was delisted from the Pharmaceutical Benefits Scheme (PBS). ASHM have received reports from community that despite this, Truvada® is still being written on some scripts, causing confusion at pharmacies and in some cases, patients are being charged up to $170 per script.

 

Please do not use the drug name Truvada® on your scripts. Instead, choose one of the alternatives below. 

 

The ASHM Antiretroviral (ARV) Guidelines Committee recommend that patients currently receiving Truvada® can transition to other combination medicines that contain tenofovir disoproxil. These are: tenofovir disoproxil fumarate/emtricitabine (Apotex), tenofovir disoproxil maleate/emtricitabine (Mylan), and tenofovir disoproxil phosphate/emtricitabine (Tenofovir EMT GH). This recommendation is for the prevention of acquisition of HIV in pre-exposure prophylaxis (PrEP), and for the treatment of HIV in combination with other antiretrovirals as recommended by the Department of Health and Human Services (DHHS) (1). 

 

The listed alternatives are all indicated for PrEP on the PBS general schedule, and are brand equivalent. See the PBS listings here.

 

Switching your patient to an alternative PrEP brand not only provides an opportunity for sexual health screening, it also offers a platform for talking about social distancing measures and avoiding contact with others to prevent transmission of COVID-19. In line with information provided to the general population, LGBTI and HIV organisations are encouraging their communities not to have casual sex at this time, however, depending on their reasons for being on PrEP, many people will prefer to continue taking their medication as before to keep their routine and to ensure they maintain their level of protection against HIV infection. Some people may choose to switch from taking daily PrEP to on-demand PrEP. If your patient is considering switching their routine, or stopping PrEP for any reason, make sure you help them do this safely (see the updated ASHM PrEP Guidelines).

 

In addition, it is important to reassure patients that antiretroviral drug supply is not, nor is it likely to be compromised. It is also important to reiterate that, contrary to reports of HIV drugs being trialled as treatment for COVID-19, there is currently no evidence on whether antiretroviral medications (including PrEP) provide protection against COVID-19. 

 

Lastly, speak to your patients about their psychological well-being, possible isolation, as well as alternative suggestions for sexual connections. Thorne Harbour Health have more information on their website and created a handy info sheet, and ACON have developed this great resource and  video.

 

We strongly encourage you to inform your affected patients now of these changes to assist in their transition to an alternative therapy.

 

If you have any questions or require further information in the meantime, please contact: HIVPrescriber@ashm.org.au 

 

1.  DHHS. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents US Department of Health and Human Services https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0