Individuals who are on PrEP

Switching from PrEP to PEP is only recommended if:

the exposure risk warrants 3-drug PEP, AND
adherence to PrEP has been < 4 doses in the week of the exposure(s), AND
the last exposure event occurred within the 72-hour PEP window.

See Table 8 for guidance. If switching from PrEP to PEP occurs in an emergency department, expert advice should be sought and the individual referred back to their PrEP prescriber as a matter of urgency.

If the individual is presenting for PrEP and they have had a possible exposure within the last 72 hours, they should be offered PEP and can then be transitioned to PrEP once confirmed to be HIV-negative.

Table 8. Switching from PrEP to PEP

Risk event	Adherence to PrEP	Recommendations
Requires 3-drug PEP	At least 4 doses in the week of the risk event(s)	Continue PrEP. Consider risk-reduction counselling.
Requires 3-drug PEP	< 4 doses in the week of the risk event(s)	Transition to 3-drug PEP if last risk event is within the 72-hour PEP window. Thoroughly assess context of adherence difficulty and intervene. Test for HIV at PEP initiation and completion. Re-commence PrEP on completion of 28 days of PEP. Reassess adherence and consider increasing frequency of monitoring.
Requires 2-drug PEP	< 4 doses in the week of the risk event(s)	Continue PrEP. Thoroughly assess context of adherence difficulty, intervene and increase monitoring. Test for HIV.