Clinical Excellence Guide

PrEP Provider Workflow Guide

A comprehensive, step-by-step workflow for healthcare providers to deliver effective PrEP services—from initial patient assessment to ongoing monitoring and care.

Positive young physician man explaining good optimistic examination results to happy male patient, showing paper file on clipboard, smiling, Doctor giving consultation in medical office

Step-by-Step

Clear, actionable steps for each stage

Evidence-Based

CDC and Illinois guidelines

Time-Efficient

Streamlined for busy practices

Complete Process

PrEP Workflow Steps

Follow this comprehensive workflow to provide optimal PrEP care from initial consultation through ongoing monitoring.

1

Initial Assessment

Evaluate patient eligibility and conduct comprehensive risk assessment

  • Review sexual history and HIV risk factors
  • Screen for contraindications (pregnancy, kidney function)
  • Discuss PrEP benefits, side effects, and adherence
2

Laboratory Testing

Order baseline labs to ensure safe PrEP initiation

  • HIV test (4th generation Ag/Ab or RNA)
  • Creatinine/eGFR for kidney function
  • Hepatitis B surface antigen and antibody
  • STI screening (gonorrhea, chlamydia, syphilis)
  • Pregnancy test (if applicable)
3

Prescription & Counseling

Prescribe appropriate PrEP medication and provide patient education

  • Prescribe TDF/FTC or TAF/FTC (daily dosing)
  • Review adherence strategies and side effects
  • Provide written materials and resources
  • Assist with medication access/insurance
4

Follow-Up Schedule

Establish regular monitoring to ensure safety and effectiveness

1 Month Follow-Up
  • • Assess adherence and side effects
  • • HIV test, creatinine
Every 3 Months
  • • HIV test, STI screening
  • • Creatinine (if on TDF/FTC)
  • • Risk reduction counseling
Every 6-12 Months
  • • Hepatitis C screening (if indicated)
  • • Reassess risk and continuation
5

Ongoing Care & Support

Maintain long-term engagement and optimize patient outcomes

  • Address adherence barriers proactively
  • Provide ongoing risk reduction counseling
  • Connect to support services as needed
  • Monitor for medication side effects

Need Additional Support?

Our clinical team is available to help you implement this workflow in your practice

Contact Our Team
At-a-Glance Reference

Quick Reference Guide

Essential information for quick access during patient encounters

PrEP Eligibility Criteria

Who should be offered PrEP

Sexual Activity Risk Factors

  • ✓ HIV-positive sexual partner
  • ✓ Condomless anal/vaginal sex in past 6 months
  • ✓ STI diagnosis in past 6 months
  • ✓ Multiple sexual partners

Injection Drug Use

  • ✓ Sharing injection equipment
  • ✓ Sexual partner who injects drugs

Other Considerations

  • ✓ Commercial sex work
  • ✓ Recent sexual assault
  • ✓ Transactional sex

Contraindications

When NOT to prescribe PrEP

Absolute Contraindications

  • • HIV-positive status (confirmed)
  • • Unknown HIV status with symptoms of acute HIV
  • • eGFR <60 mL/min (for TDF/FTC)
  • • Hypersensitivity to medication components

Relative Contraindications

  • • Chronic kidney disease (use with caution)
  • • Osteoporosis or bone fracture risk
  • • Active hepatitis B (requires monitoring)
  • • Adolescents under 35 kg (weight-based dosing)

Laboratory Testing Schedule

Required monitoring timeline

Test Baseline 1 Month Every 3 Months Every 6-12 Months
HIV Test (Ag/Ab or RNA)
Creatinine / eGFR
Hepatitis B (HBsAg, HBsAb) If unvaccinated
STI Screening (GC/CT, Syphilis)
Pregnancy Test If applicable If applicable
Hepatitis C Antibody If risk factors

Note: Testing frequency may need to be adjusted based on individual patient risk factors and clinical judgment. More frequent monitoring may be appropriate for some patients.

Download Complete Workflow Guide

Get a printable PDF version of this workflow for your clinic or practice

Free for all Illinois healthcare providers

Common Scenarios

Clinical Scenarios & Solutions

Real-world scenarios and practical guidance for common PrEP challenges

SCENARIO 1 Patient Misses Follow-Up Appointments

"A patient on PrEP has missed their last two 3-month follow-up appointments. How should I manage their care and prescription refills?"

Recommended Approach:

  • • Contact patient via phone/text to understand barriers
  • • Require HIV test before refilling prescription (can offer rapid test)
  • • Consider telemedicine visit for adherence check-in
  • • Provide short-term refill (30-day) until labs completed
  • • Implement reminder system for future appointments

SCENARIO 2 Declining Kidney Function

"A patient's eGFR has decreased from 75 mL/min to 58 mL/min while on TDF/FTC. What steps should I take?"

Recommended Approach:

  • • Discontinue TDF/FTC immediately if eGFR <60 mL/min
  • • Consider switching to TAF/FTC (Descovy) which is safer for kidneys
  • • Recheck creatinine in 2-4 weeks to assess for improvement
  • • Review other medications that may affect kidney function
  • • Refer to nephrology if eGFR continues declining

SCENARIO 3 Patient Reports Side Effects

"A patient starting PrEP reports nausea and headaches in the first week. Should they continue medication?"

Recommended Approach:

  • • Reassure that mild GI symptoms and headaches are common initially
  • • Symptoms typically resolve within 2-4 weeks
  • • Suggest taking with food to reduce nausea
  • • Recommend taking at bedtime to sleep through side effects
  • • Follow up in 1-2 weeks to reassess symptoms
  • • If persistent/severe: consider switching TDF/FTC to TAF/FTC

SCENARIO 4 Patient Cannot Afford Medication

"A patient wants to start PrEP but is uninsured and cannot afford the medication cost. What resources are available?"

Recommended Approach:

  • • Enroll in Gilead Advancing Access program (covers medication & labs)
  • • Apply for patient assistance through manufacturer co-pay cards
  • • Connect to Ready, Set, PrEP federal program (uninsured individuals)
  • • Explore state PrEP assistance programs in Illinois
  • • Prescribe generic TDF/FTC (often <$30/month)
  • • Refer to community health centers with sliding scale fees

SCENARIO 5 Potential HIV Exposure While on PrEP

"A patient on PrEP reports missing several doses recently and had potential HIV exposure. What should I do?"

Recommended Approach:

  • • Assess adherence: if <4 doses in past week, PrEP protection may be incomplete
  • • Consider PEP (post-exposure prophylaxis) if within 72 hours of exposure
  • • Test for HIV immediately (4th gen Ag/Ab test)
  • • Repeat HIV testing at 4-6 weeks post-exposure
  • • Counsel on importance of daily adherence for full protection
  • • Explore adherence barriers and support strategies

Need Clinical Consultation?

Our team of PrEP specialists is available to discuss complex cases and provide clinical guidance

Request Consultation