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PrEP stands for Pre-Exposure Prophylaxis. It comprises of 2 anti-viral medications tenofovir and emtricitabine (TDF and FTC) and is highly effective in reducing the chances of contracting HIV infection. The use of PrEP is now recommended in national guidelines in many countries. The World Health Organization recommended in 2015 that PrEP should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches, and in 2017 published an implementation tool to guide countries on the introduction and implementation of PrEP. HIV transmission among men who have sex with men (MSM) has been rising in Singapore as it has in most other countries, indicating the need for additional methods at HIV prevention such as PrEP.
Men who have Sex with Men (MSM)
The iPrEx study was a double-blind, placebo-controlled, multi-centre trial. The TDF/FTC group was associated with a 44% reduction in the risk of HIV acquisition (95% CI, 15-63). When blood samples were tested for the medication, there was a 92% reduction in the risk of HIV acquisition in persons with detectable levels of TDF/FTC versus those without.
The IPERGAY study was a double-blind, multi-centre trial. The on-demand regimen involved taking 2 tablets of TDF/FTC 2 to 24 hours before sex, 1 tablet a day during periods of sexual risk and for 48 hours (two doses) after sex. The study was stopped early when it showed that 14 people became infected with HIV in the placebo group compared with 2 in the TDF/FTC group, a risk reduction of 86%.
The PROUD study was a randomised, open-label trial in England. A total of 23 participants became infected with HIV over the course of the study; three in the daily TDF/FTC group and 20 in the deferred group. This represents a risk reduction of 86%.
Heterosexuals
The Partners PrEP trial was a double-blind trial of daily TDF/FTC or TDF in Uganda and Kenya conducted from 2008 to 2010. Compared to placebo, the overall efficacy estimates was 75% for TDF/FTC, and 67% for TDF alone. When blood TDF levels were measured, for participants in the TDF/FTC group, detectable drug was associated with a 90% reduction in the risk of HIV acquisition.
Injecting Drug Users
The Bangkok Tenofovir Study was a double-blind, placebo-controlled trial. The efficacy of TDF was 48.9%, however detectable levels of TDF in the blood was associated with 73.5% reduction in the risk for HIV acquisition.
The effectiveness of PrEP for HIV prevention is therefore directly related to taking the medication.
The clinical trials also provided safety information on PrEP. Some people in the trials had early side-effects such as an upset stomach loss of appetite but these were mild and usually went away within the first month. Some people also had a mild headache. No serious side-effects were observed. You should tell your doctor if these or other symptoms become severe or do not go away.
Daily PrEP
For MSM, heterosexual men and women, sex workers, trans persons
Daily dosing of co-formulated TDF/FTC. Needs to be taken for 7 days before high levels of protection are achieved for both vaginal and rectal exposure to HIV.
On-Demand PrEP
For MSM only
A double dose (two tablets) of co-formulated TDF/FTC to be taken 2-24 hours before potential sexual exposure, to be followed by single doses 24 and 48 hours after the initial dose
FOLLOW-UP WITH YOUR DOCTOR
Taking PrEP medicines will require you to follow up regularly with your doctor. You will have blood tests for HIV and tests to see if your body is reacting well to the medication. You will also receive counselling to reduce the risk of acquiring HIV. You should take your medicine as prescribed, and your doctor will advise you about ways to help you take it regularly so that it stands the best chance to help you avoid HIV infection. Tell your doctor if you are having trouble remembering to take your medicine or if you want to stop PrEP.
PrEP is offered as part of a comprehensive HIV/STI prevention package. PrEP does not protect you against other sexually transmitted infections (STI) like syphilis or gonorrhoea. If you have started taking PrEP, it is important for you to return for regular STI screening. Condoms provide the most effective barrier to HIV and are also the best way of reducing your chances of picking up or passing on other STI.
First visit
Use 4th generation HIV test (either conventional HIV EIA or rapid blood test). If there was recent high-risk exposure, it is advisable not to rely on a rapid test as these are less sensitive that conventional EIA. If last high-risk exposure in the last 4 weeks ago, repeat HIV test after 4 weeks .
Check kidney function, Syphilis, HBV, HCV, gonorrhoea and chlamydia tests
Subsequent visits (3 monthly is advised)
HIV, Syphilis, HBV, HCV, gonorrhoea and chlamydia tests.
Kidney function tests every 6 to 12 months.
Need more information? Chat with us.
Click that pink messenger button at the bottom right corner to chat with us if you need more information before you start PrEP.
WHAT ARE THE OPTIONS FOR OBTAINING PrEP?
If you are considering PrEP, you should discuss this with a doctor with experience in HIV or sexual health to help decide if PrEP is right for you.
This fact sheet explains your options for obtaining PrEP through the local health system. Your doctor can prescribe Truvada, which is the original brandname combination of tenofovir and emtricitabine (TDF and FTC) manufactured by Gilead. The cost is approximately $400 per month for Truvada, which will be too expensive for many people. Another option is to purchase a generic version of tenofovir and emtricitabine (TDF and FTC) from a reliable online supplier. Generics are copies of brandname drugs. The cost of generic tenofovir and emtricitabine (TDF and FTC) is much less than the brand-name.
You are allowed to bring in or import medicines for personal medical use if the quantity is less than or equal to 3 months’ supply.
Buying Medicines Online
The internet can offer consumers a convenient and less expensive way to access medicines. However, online purchases of medicines should be approached with caution. Medicines available on international websites are not regulated by the local authorities. You need to as far as possible ensure that the website is legitimate, otherwise there are possible risks, including that medicines are fake, past their use-by date or not manufactured to appropriate standards. Medical information from the internet should also never replace consultation with your doctor and should be interpreted with caution.
NCID/TTSH HIV PrEP Clinic
Email: prepcare@ttsh.com.sg
Phone number: 6357-7900
Operating Hours
Mondays to Fridays: 8:30 am to 5:30 pm
Saturdays: 8:00am to 12:00pm
Sundays and Public Holidays: Closed
NUH BePrep clinic
- Operating Hours (*Strictly by appointment only)
- Thurs: 2.00pm to 5.00pm
- Contact
- To make an appointment
- Phone: (65) 6772 2002
- Email: appointment@nuhs.edu.sg
- For all other enquiries
- Email: bpc@nuhs.edu.sg
- To make an appointment
WHERE CAN I FIND OUT MORE?
For more information on importing medicines for personal use, please visit this page from the Health Science Authority’s website.
For more information on Truvada or generic tenofovir and emtricitabine (TDF and FTC) for PrEP, talk to Action for AIDS, your doctor or Sexual Health clinic.
gayhealth.sg’s & AFA's information are intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.
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