Ask AI
Back Back
HIV Prevention From Guidelines to Needs
Moving HIV Prevention From “Which Guideline?” to “What Does This Patient Need?”

Released: June 04, 2026

Christina M. Madison
Christina M. Madison, PharmD, FCCP, AAHIVP
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • HIV prevention guidance is moving away from “risk-based” conversations and toward inclusive, patient-centered eligibility discussions.
  • HIV prevention strategies are stronger when nPEP and PrEP are connected.
  • Low-barrier prevention models, such as same-day initiation, standing orders, pharmacy-based services, nursing-led workflows, telePrEP, public health protocols, and “PEP-in-pocket” strategies can reduce missed opportunities for HIV prevention.

We now live in a world where there are multiple HIV prevention options for our patients. Although this is undoubtedly advantageous, the number of available recommendations can feel overwhelming. The CDC, IAS-USA, NYSDOH, WHO, BHIVA, EACS, and DHHS Perinatal HIV guidelines all provide important direction, but they do not always answer the clinical questions in exactly the same way. Healthcare professionals (HCPs) are often asked to navigate the nonoccupational postexposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP) guidelines, which can seem daunting.

HIV prevention monitoring and follow-up is one of the most practical places where guideline differences matter. Some guidelines provide more detailed recommendations about HIV antigen/antibody testing, HIV-1 RNA testing, oral PrEP overlap with long-acting injectable cabotegravir, event-driven dosing, and duration of oral PrEP after last exposure. But you do not need to treat these differences as competing instructions. Instead, use them to build protocols that fit your patient population, clinical staffing, laboratory access, and follow-up capacity.

Starting With the Individual
The best place to start is with the patient in front of you. One of the most important shifts across contemporary HIV prevention guidance is the movement away from “risk-based” conversations and toward more inclusive, patient-centered eligibility discussions. Instead of waiting for patients to self-identify as being “at risk,” you, as an HCP, should be normalizing sexual health, substance use, and HIV prevention conversations as routine parts of care. 

This matters because stigma remains one of the most persistent barriers to nPEP and PrEP uptake. If our clinical language makes patients feel judged, they may not disclose the information we need to guide care. If our systems make HIV prevention feel exceptional, difficult, or shame based, patients may never return.

Synchronizing nPEP and PrEP
Although you might discuss nPEP less often than its HIV prevention sibling, PrEP, there is strength in connecting these 2 opportunities for protection. I believe every patient asking about PrEP should first be asked about possible HIV exposure of concern within the last 72 hours. If a potential exposure occurred, that person may need nPEP first. The reverse is also true. Every patient who receives nPEP should leave the encounter knowing that PrEP may be an option after the 28-day nPEP course is complete.

One of the great benefits of connecting nPEP and PrEP is that, if patients test HIV negative at the time of nPEP completion, they can immediately transition to their preferred PrEP option. Synchronizing helps minimize gaps in protection.

Constructing Low-Barrier Models for Prevention
Unfortunately, we cannot counsel our way out of structural barriers. HIV biomedical prevention is highly effective, but uptake remains far below what is needed to meet national prevention goals. Implementation requires asking hard questions: Who is on the team? Who can start the conversation? Who can order labs? Who can provide adherence support? Who can help with insurance coverage, patient assistance, and follow-up?

Low-barrier models matter and can make a big difference. Same-day starts, standing orders, pharmacy-based services, nursing-led workflows, telePrEP, public health protocols, and “PEP-in-pocket” strategies can all reduce missed opportunities. These models are especially important for patients who may not have consistent access to traditional primary care or specialty services. 

Pharmacist-led PEP and PrEP programs provide particularly useful inspiration. Kelley-Ross One-Step PrEP in Washington state is an excellent example of one such program; it demonstrates how community pharmacies can become direct HIV prevention access points when paired with lab workflows, follow-up, financial navigation, and telehealth options. Illinois’ statewide standing order model is another example that shows how public health infrastructure can support pharmacist-provided PrEP at scale. Louisiana’s Act 711 is also important because it authorizes pharmacist-initiated PrEP and PEP for individuals aged 17 years of older, which is especially meaningful in a region with high HIV burden and persistent access barriers.

These models remind us that implementation does not always require building an entirely new system. Sometimes it means expanding the authority and workflow of professionals already embedded in the community.

Normalizing HIV Prevention
HIV prevention is not specialty care; it is everybody care. Primary care, women’s health, sexual health, urgent care, community pharmacy, and public health settings all have an important role to play.

Evidence from implementation models in primary care and women’s health shows that building PrEP workflows into existing sexually transmitted infection diagnosis and treatment processes can increase the number of PrEP prescribers, prescriptions written, and patients receiving PrEP. This is especially important for cisgender women and other populations who have historically been underrepresented in PrEP messaging, prescribing, and outreach.

For HCPs, this means that PrEP should not be framed as something only certain patients need or only certain specialists provide. It should be part of routine preventive care services.

My Clinical Takeaway
Choosing among nPEP and PrEP guidelines requires you to ask 3 important questions:

  1. Which guideline best answers the clinical question in front of me today?
  2. Does my workflow allow patients to start prevention quickly, safely, and without unnecessary barriers?
  3. Am I creating a system where HIV prevention is normalized, accessible, and connected to the rest of the patient’s care?

Guidelines are essential, but implementation is where prevention succeeds or fails. The most effective protocol is not the one that sits neatly in a policy binder. It is the one your team can actually use when a patient walks in, discloses a recent exposure, asks about PrEP, misses doses, changes partners, becomes pregnant, faces cost barriers, or simply needs a trusted HCP to say, “You have options, and we can help.”

Your Thoughts?
How is your clinic, pharmacy, or public health program integrating nPEP and PrEP into routine care? What implementation barriers are you still working to solve?

Continue