HIV Pre-Exposure Prophylaxis

Publication Date: January 1, 2019
Last Updated: March 14, 2022

Summary Statements

Basic Science

  • Daily Tenofovir/Emtricitabine (TDF/FTC) is over 90% effective in preventing HIV if taken regularly.
  • TDC/FTC does not offer protection from other STIs and is meant to be used with barrier protection.

Side Effects and Contraindications

  • The contraindications for PrEP are unknown or positive HIV status and chronic renal insufficiency defined as eCrCL <60 ml.
  • Hepatitis B infection is not a contraindication to PrEP use, but students with chronic active hepatitis B should receive expert consultation
  • Side effects are minimal.
  • The development of drug resistance to TDF/FTC during PrEP has occurred very rarely.

Introducing PrEP

Be proactive in talking about PrEP—don’t wait for the student to ask. Dispel myths.

Initial Evaluation

Initial testing includes an HIV test, serum creatinine (Cr) and estimated GFR (eGFR), hepatitis B surface antigen (HBsAg), and STI testing. See Appendix for sample protocols.

Common Concerns

Financial Barriers

Substantive financial resources exist for college students that will allow most to obtain TDF/FTC without any out of pocket expense.


Confidentiality is a real concern for students who are on another person’s insurance plan, and they may need help navigating Explanations of Benefits (EOBs). Some insurances are open to redirecting EOBs.

Providing PrEP During the Summer

Suggestions for providing PrEP over summer break include providing a four-month supply, having a telehealth visit, and having student obtain an HIV test locally that is emailed to their college health service provider.

Increased Risk-Taking

Data is mixed on whether PrEP causes riskier sex, thereby increasing rates of STIs, but overall the effect seems minimal or even to decrease rates of STIs.


Utilize sample protocols and the expertise of colleagues with experience in implementing PrEP.

Recommendation Grading




HIV Pre-Exposure Prophylaxis

Authoring Organization

Publication Month/Year

January 1, 2019

Last Updated Month/Year

June 12, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

This document was created to provide a roadmap and a resource for college health services in providing PrEP and to assist with front line implementation.

Target Patient Population

Patients with high risk for HIV infection

Inclusion Criteria

Female, Male, Adolescent, Adult

Health Care Settings

Ambulatory, Outpatient, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D015658 - HIV Infections, D006678 - HIV, D011315 - Preventive Medicine, D019380 - Anti-HIV Agents


human immunodeficiency virus (HIV), HIV infections, preventive care, HIV

Source Citation

“Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis” at