What Is On-Demand PrEP?
Definition and Basic Principles
On-demand PrEP, also known as event-based PrEP, is a strategy for HIV prevention that involves taking antiretroviral medication around the times of potential HIV exposure rather than daily. This begins with the underlying principle that antiretroviral medications can block HIV infections when they are in the body upon exposure or right after exposure. To custom-made scheme is very convenient for those who have rare sexual contacts or who can well-arrange their sexual relationship
Dose-Skip Days in Daily PrEP Regimens.
An on-demand behavior-active PrEP is in contrast to a daily regimen, offering flexibility and distinction by being taken as many times as the distance between exposures. Intraday PrEP requires taking pills daily and making sure that the level of the drug in the blood stays the same. And on-demand PrEP involves taking pills before and after the sexual contact. This may help to eliminate many pills over an extended time, bringing more people on board this method.
Becoming Aware of the Science Fact of On-Demand PrEP
Pharmacokinetic studies and clinical trials including randomized controlled trials as well as observational studies have confirmed the safety and effectiveness of on-demand PrEP. Such findings indicate that taking two doses of the medication that protect against HIV before potential exposure, the event followed by subsequent doses after the event will ensure the integrity of the mechanism for prevention of HIV.
This dosing strategy is often referred to as the 2:A 1:1 program will be held with recommended dosing before the exposure, one pill just after 24 hours, and the last pill after another 24 hours has passed.
“As on-demand PrEP might become an alternative to daily medication, it could also make the treatment more reliable. If one uses such pills only in the situations when there is a risk of HIV transmission, then the number of all consumed pills will probably be smaller.”
Eligibility and Target Populations
Criteria for On-Demand PrEP Use
On-demand PrEP is designed for individuals who do not have HIV and are at high risk of acquiring it but may not have consistent exposure warranting daily medication. Eligibility criteria include a negative HIV test, no signs of acute HIV infection, and a clear understanding of the regimen’s requirements.
Demographics Affected by HIV.
Concerning groups in the population are multiplying the rate of human immunodeficiency virus in different categories like men who have sex with men (MSM), transgender individuals, and minorities among racial or ethnic groups. Following up with those populations should be a key factor in the battle for the reduction of the HIV spread.
Understanding Risk Factors
Risk factors for HIV include unsafe sex, several partners, and using an IV when inhaling drugs. Discovering these components is the path to unlocking a piece of the puzzle on the use of on-the-spot PrEP, which is vital for healthcare providers as they advise individuals on this matter, and for those applying for its use.
Administration of On-Demand PrEP
Dosage and Scheduling
On-demand PrEP (DO PrEP) involves a specific dosing schedule that differs from daily PrEP regimens. Approaching DO PrEP with a uniform strategy involves ingesting two pills from 2 up to 24 hours before possible HIV encounter, using one pill 24 hours after the first pill, and another after the second and fourth pill. This approach, in turn, requires us to plan sexual encounters and take them (medicines) at the right time.
- Initial dose: 2 pills pocket yourself before the endpoint.
- Subsequent doses: one a day starting 24 hours after the 1st dose and repeating it one more day later.
On the other hand, interrupting and restarting the entire treatment would only push the treatment time even further.
DO PrEP inception denominates understating transmission probability of HIV by considering the timing of exposure. The discontinuation of the mode of action needs to be done in collaboration with a health expert, who may dictate it based on a specific case and risks associated with the involved partner’s social behavior. One should take into account that DO PrEP may not be the best method for people with several irregular sexual encounters that are associated with the question of determining doses.
Counseling for Adherence
Keeping to the DO PrEP schedule is so intrinsical that it determines the power of the drug. Counseling sessions should focus on the necessity to avoid exposure unless specifically advised by the doctor and should stress the need to take all prescribed medications. Healthcare providers must promote strategies for the patient to know his/her dosing schedule and factors that may cause the patient to neglect the prescribed treatment. Blockquote: The importance of counseling for adherence is disregarding the assumption that the services are simply about reminding patients to take their medicine. On the contrary, the services strive to empower the patients with the necessary skills to ensure the successful implementation of HIV prevention on their own.
Clinical Trial Outcomes
Clinical trials are the clinical trials that reveal the effectiveness of pharmacological and medical interventions. Engaging PrEP services with PrEP being provided on demand has been subjected to extensive testing by different clinical trials and the outcomes have consistently proved the high level of protection against HIV when the regimen is adhered to. Cumulative evidence from various PrEP trial studies found that it is not mandatory to have 100 per cent dosing adherence in women and that this might convince a lot of them to adopt this method of preventing HIV.
Real-World Effectiveness
While clinical trials may provide a laboratory-like environment, these differences may occur in real-world settings where other variables such as patient adherence and the ease of access to the prescribed medication may influence the outcomes. Observations have indicated that the effectiveness rate of on-demand PrEP remains above 99% in real-life environments as clinical trials would guide us. However patient monitoring and assessment are prioritised as they have the power to demonstrate the impact of PrEP when used to prevent HIV. On-demand PrEP is a rather new concept and requires assessing how it fits the real-world demand logistics and the effectiveness of this method in conjunction with other prevention approaches.
“We need to think about the policies, community engagement, and public health strategies that enable on-choice PrEP to work best in actual circumstances.”
Overall, in terms of comparative efficacy with other prEP modalities, the ultimate goal should be to examine and prioritize strategies that are the most cost-effective.
Comparing the decision-making associated with daily PrEP with other modalities, like the long-acting injectable PrEP (LA-PrEP), is a layer of contrast to understand the client’s preferences and the clinical implications. The phenomenon is such that people seem to lean more towards drugs which have proven to be more effective, with studies showing a strong preference for LA-PrEP with 99.9% assurance when it comes to lower effectiveness levels. While the comparative effectiveness of on-demand PrEP versus other forms must be evaluated in the context of personal needs, potential side effects, and viability of implementation in a clinical setting, on-demand PrEP holds promise to offer greater convenience to high-risk individuals, who may stand to benefit from this approach.
Barriers to Access and Adherence
Logistical Challenges
Access to on-demand PrEP can be hindered by logistical challenges, such as limited accessibility to healthcare providers and pharmacy services. It is not uncommon problem for rural areas to be without any specialists but the most difficult one is laboratory testing. Furthermore, the general roadblock to PrEP adherence because of the everyday logistics is too often seen, and it affects so many people who have a complex schedule or who fail to maintain a consistent routine.
Stigma and Psychosocial Factors
There is a shallow thought that if a person takes PrEP and thus far has not become HIV-positive, he should neither adhere to risk-reducing strategies nor any other preventive measures, such as regular HIV tests. The possible consequences of stigma, mistrust of medicines, and the fact that sexual issues are not straightforward to talk about with a general practitioner can restrain PrEP uptake. Psychosocial concerns such as mental health issues and drug use have an impact on both the adherence and access of HIV/AIDS patients necessitating that we address these problems in a supportive manner.
Insurance and Cost Issues
The issue of how much on-demand prevention and insurance will cost is key to the accessibility of this treatment. Even though it has proven to be very effective, lots of people are not getting access to it mainly because of the financial constraints that bar many of the citizens who are recommended for the use of PrEP. The table below illustrates the disparity in PrEP prescription among those for whom it is recommended: The table below illustrates the disparity in PrEP prescription among those for whom it is recommended:
| Population Recommended for PrEP | Percentage Prescribed PrEP |
| 1.2 million people | 25% |
Ensuring optimal protection against HIV requires addressing these financial barriers to improve PrEP adherence and access.
Safety and Side Effects
Common Side Effects
On-demand PrEP, like any medical intervention, comes with potential side effects. The most frequently reported include depression, dizziness, upper respiratory infections, rash, and sleeplessness. These side effects are generally mild and manageable. For instance, in clinical trials, a notable percentage of participants experienced moderate pain at the injection site, similar to that of a flu shot, which typically resolved within a week.
- 25% chance of moderate pain at the injection site
- 15% chance of headache
- 5% chance of rash
Long-Term Health Considerations
The safety pattern of PrEP over a long time could be regarded as a key part of its overall analysis. Long-term research has the utmost significance in terms of assessing the effects on bone density, kidney functioning, and other health parameters over time. It is patients who are instructed to do regular check-ups serially and abnormal effects should be reported to doctors immediately.
Managing Adverse Reactions
Besides other health practitioners, when side effects of take-when-needed PrEP occur healthcare providers have a significant position in managing them. Education for people on the rarity of serious downsides should be in place. It is undoubtedly the major determinant in the uptake and adherence to immunization. It is pivotal for the patient to be provided with information on potential injection site reactions or pain among the common adverse reactions, and offered with coping techniques for getting rid of the pain.
“While the injection site reactions or pain is the most common adverse effects, they are just temporary and can be easily managed with the right therapeutic approach”
Comparing On-Demand PrEP with Long-Acting Injectable PrEP
Pros and Cons of all Strategy Types
Expecting demand for AIDS and long-term LA PrEP are two different kinds of HIV prevention. With on-demand PrEP, an oral dose of PrEP taken before and after sex, individual use becomes flexible and subject to an individualized schedule/ LA-PrEP, an injectable form of PrEP given bi-monthly as an alternative to the daily oral dosage, offers great benefit with regards to compliance to taking the drug by delivering the treatment once in a fortnight. On the other hand, staff will occasionally administer it by injection which may lead to some adverse reactions at the injection site. It depends on individual votes as to which is better- one method or the other.
Patient Preferences and Satisfaction
There are many kinds of preferences according to patients, departure from one area to another for example taking the LA-PrEP convenient drug over the daily business of taking the oral kind of PrEP. The results of a study show that if one were forced to choose between an LA-PrEP that is very close to 100% effective and an oral option that is about 95% effective one would select the LA-PrEP. Participants were highly satisfied with the drug and shared the opinion that once a month dosing perfectly suited their needs and having clinic visits limitations was not a challenge.
Implications for Clinical Practice
Due to numerous differences between on-demand and LA-PrEP, healthcare professionals need to know the latest developments in this field to help people with the HIV prevention strategy of their choice. Not only the implementation of LA-PrEP but also individualized treatment plans based on each patient have emerged hence providing the health care premises with more tools to combat this disease. Medical professionals must do this kind of informational disclosure so that they can provide patients with trustworthy information, as well as oblige them to choose the correct PrEP method and later on help them stick with it.
Impact on Key Populations
The Consistencies for Ready-to-Use PrEP Consideration.
The significant role of on-demand PrEP, which can be dubbed event-driven PrEP, includes enabling it to be a helpful tool specifically for key populations as they are more at risk of the aforementioned infection. The applicability of PrEP is based on the individual needs and behaviour patterns of these groups, which makes it very specific and it is therefore very efficient even though those groups may not adhere to the daily routine doses of PrEP.
Specific Age & Sex
Members of men who have sex with men (MSM), transgender individuals, as well as certain racial and ethnic minority populations are facing HIV at a disproportionate rate. Targeting HIV prevention initiatives, involving on-demand PrEP, to these demographics is an imperative move for cutting the number of HIV cases in the whole big picture and battling health disparities.
Understanding Risk Factors
HIV transmission is closely linked with different risk factors and those vary between key populations with evidence showing that sexual habits, trug abuse and access to health facilities as the most responsible. This risk factor recognition is of paramount importance in the run of a successful on-demand PrEP program and for the design of prevention strategies. This being said, the knowledge of the risk factors is of paramount importance.
Effect on Men Who Have Sex with Men (MSM)
MSM remains one of the most significantly impacted groups by HIV. Studies like the EPIC-NSW trial have demonstrated the population-level impact of PrEP, highlighting the importance of on-demand PrEP as a flexible and responsive prevention option for this community.
PrEP for Cisgender Women
Females, who identify as cis-women, are on the front line to also gain from the emerging innovations in PrEP, especially in regions where the disease burden of the virus is high. The PrEP method for women must undergo a comprehensive biological assessment which will take into account factors like female sexual health and the possible drug interactions with contraceptives of hormonal origin.
For Transgender individuals.
Transgender people experience a variety of restrictions in the scope of HIV prevention. Calling-for-on-demand-PrEP can be customized based on hormone therapy and other factors specific to transgender health. This approach can meet the needs of a diverse group of people in the LGBTQ+ community.
“On-demand PrEP featured a new model, which was adjustable and applicable to specific key populations and consequently, their lifestyle. The new model combined the lives of the key populations with their preferences”.
Antiretroviral therapy was a turning point in the fight against HIV and AIDS.
Innovations in PrEP Delivery
With the development of new strategies for PrEP administration in addition to pre-exposure prophylaxis (pre-exposure prophylaxis), the landscape of HIV prevention is at hand to be reshaped. Novotny Research volunteer: Many activist groups work to bring public opinion on the importance of funding for these areas. These achievements are designed with various needs and tastes of the people targeted in mind and often such improvements may enhance adherence and proper performance of the mechanism which will thus lead to maintenance of safety.
Expanding Access and Reducing Disparities
Efforts to expand access to PrEP are crucial in the fight against HIV. Initiatives like ‘Ready, Set, PrEP’ have been instrumental in increasing availability, particularly among underserved communities. However, current implementation efforts have failed to achieve equitable PrEP provision for transgender and gender-diverse individuals. Addressing social barriers and integrating STI services into HIV prevention are key strategies to boost screening rates and reduce disparities.
PrEP has to be implicitly incorporated into comprehensive HIV prevention programs as a potential tool to decrease the high prevalence rates of this infection.
Both PrEP integration in the broader HIV prevention framework and comprehensive strategy is a matter of successful and holistic HIV prevention. This includes a multipronged combination approach of PrEP, coupled with other prevention measures like condoms and regular testing. The clinical and staffing demands of doing LA-PrEP call for studies that are implantation-oriented and aim to negotiate systems-related challenges in the lab, clinic, pharmacy, or insurance networks ensuring that PrEP is a seamless part of an integrated HIV prevention approach.
Conclusion
Therefore, on-demand PrEP is a great achievement in HIV prevention approaches with the same level of anti-HIV protection, though not being used every day thereby causing fewer side effects. It is specifically suited for people who can predict that HIV will be exposed and don’t liked to take daily medication and would be more inclined to use it. The success of the on-demand PrEP strategy is confirmed by many scientific works, and it could become an option for many populations: men who have sex with men, women, and others. On the one hand, the maintained use of on-demand PrEP is significantly favoured by health benefits; on the other hand, factors such as stigmatization, psychosocial factors, and logistical difficulties continue to be the major complications. These obstacles could be overcome if more people were aware of PrEP and knew where to seek access to it. Multiple ways could be thought of to better the situation and to decrease the amount of new HIV diagnoses. Moving forward with exploring and implementing many modalities of PrEP, we consider what we listen to in patients’ preferences in using these modalities and adapt the clinics to meet those patients who are at risk of HIV.
References
- https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing
- https://link.springer.com/article/10.1007/s11904-024-00696-y
- https://www.prepwatch.org/wp-content/uploads/2024/03/PrEP-Handbook-EN-v.2-2024.pdf
- https://www.tandfonline.com/doi/full/10.1080/09540121.2024.2332443?src=
- https://www.medicalnewstoday.com/articles/prep-for-hiv
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341191/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853582/
