PrEP-RN: Clinical Considerations and Protocols for Nurse-Led PrEP

Abstract

HIV pre-exposure prophylaxis (PrEP) is an increasingly important part of the HIV prevention armamentarium. Issues with PrEP, however, include access. We propose that one way to surmount this issue would be to have nurses provide PrEP. Although clinical guidelines exist for PrEP, they are overwhelmingly not targeted to nonprescriber clinicians. In this article, we overview current U.S. and Canadian PrEP guidelines and provide explicit guidance about how nurses can provide PrEP, including the clinical pathways and medical directives we use in our clinic. We call nurse-led provision of PrEP, PrEP-RN (Pre-Exposure Prophylaxis-Registered Nurse) and feel it may be an important step forward in HIV prevention.

Figure 1.

HIV risk stratification. Note. ACB = African, Caribbean, Black communities; IDU = injection drug use; MSM = men who have sex with men; PEP = postexposure prophylaxis; STI = sexually transmitted infection.

Figure 2.

Estimated glomerular filtration rate management pathway for first visit. Note. eGFR = estimated glomerular filtration rate; FTC/TDF = 300 mg emtricitabine (FTC) plus 200 mg tenofovir disoproxil fumarate; ID = infectious diseases; LSC = last sexual contact; PEP = postexposure prophylaxis; SeCr = serum creatinine; WNL = within normal limits.

Figure 3.

Estimated glomerular filtration rate management pathway for follow-up visits. Note. eGFR = estimated glomerular filtration rate; FEP = fractional excretion of phosphate; FTC/TDF = 300 mg emtricitabine (FTC) plus 200 mg tenofovir disoproxil fumarate; FU = follow-up; ID = infectious diseases; LSC = last sexual contact; PEP = pre-exposure prophylaxis; SeCr = serum creatinine; ULN = upper limit of normal; WNL = within normal limits.