Nurses’ roles in PrEP

PrEP use in Australia as part of and individual and population HIV risk reduction strategy is now wide-spread. Nurses have an important role to play (Table 15).

Access to PrEP is crucial to realising its benefits. Nurses should be aware of those not currently benefiting from PrEP (younger men and those born overseas and without access to Medicare) and asses their barriers to and options for access.

Adherence to the PrEP dosing schedule is also crucial to realising its benfits.  Those who most need PrEP may well be those who most struggle to maintain these high levels of adherence. They will be men who have sex with men (or others) with significant alcohol or other drug issues or significant mental health problems. Rather than exclude these vulnerable groups from PrEP access, because of fears about poor engagement and adherence, ways should be found to support the adherence required.  In the IDU Bangkok PrEP study, participants received Truvada by directly observed therapy (DOT) 86% (SD 25%) of the time and were compensated for travel and the time required by the study procedures.


Nurses can and ought to have a pivotal role in exploring and providing innovative methods of PrEP medication adherence support in marginalised, vulnerable populations which could include DOT, other forms of highly supported therapy and the provision of financial incentives.

Table 15: The nurse’s role in pre-exposure prophylaxis (PrEP)

  • Providing a nurse-led PrEP service
  • Ensuring that those at risk know about PrEP and current pathways to access in Australia
  • Referring onwards to providers who can facilitate PrEP access
  • Adherence education and support
    • The need for a high level of adherence to the regimen and dosing schedule
    • Choosing the optimum dosing time based on the client’s routine work and leisure patterns including discussion around the dosing window – a rigid, fixed time to dose sets clients up to miss a dose and fail
    • Strategies to assist adherence – teaching cueing (the act of associating pill taking with a habitual behaviour), visual and electronic reminders, pill boxes, preparing for the unexpected: keeping a supply at work, in the car, in a bag, at a friend’s house, borrowing from a friend
    • What to do if a dose(s) is/are missed
    • For vulnerable groups, intensive support, case management, directly administered or observed therapy (DOT), partial-DOT, financial incentives.
  • Education about maintaining healthy bones
  • How to access help if unexpected side-effects occur
    • The nurse can provide the first port of call and access to help by encouraging re-presentation and providing telephone access and support