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Switching Between PrEP Products �& �Maintaining Continuous HIV Prevention�

PrEP OPTIONS

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Learning Objectives

  • Why a client may switch from one PrEP product to another.
  • Identify the key principles for safe PrEP switching.
  • Describe the recommended transition between different PrEP products.
  • Counsel clients on adherence during the transition period.
  • Identify when HIV testing and clinical assessment are required.
  • Develop an appropriate transition plan that maintains HIV prevention.

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Why switch a product

  • Clients may choose to change PrEP products because of:
      • Side effects
      • Availability or access
      • Convenience
      • Personal preference
      • Lifestyle considerations
      • Product-specific challenges

The goal of switching PrEP products is to maintain continuous HIV prevention without creating a gap in protection.

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Core Principles of PrEP Switching

  • Avoid protection gaps
  • Confirm clinical eligibility
  • Follow the recommended overlap
  • Reinforce adherence
  • Continue HIV prevention counseling
      • HIV testing according to the relevant protocol
      • Risk assessment
      • Adherence assessment
      • Counseling on other HIV prevention methods where appropriate

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Sharing of experience

  • Have you supported a client who switched from one PrEP product to another?

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Team work

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Switching From Oral PrEP

Transition to CAB-LA

  • When initiating CAB-LA Injection1:
  • Continue TDF-based oral PrEP for 7 days after CAB-LA Initiation Injection 1.

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Transition to DVR�

  • When inserting the Dapivirine Vaginal Ring (DVR):
  • Continue TDF-based oral PrEP for 7 days after DVR insertion.

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Transition to LEN�

  • When switching from oral PrEP to LEN, the client should:
  • Continue oral PrEP throughout both days of the LEN initiation regimen.

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Event-driven PrEP�

  • For clients using event-driven 2+1+1 dosing, continue with daily dosing of Oral PrEP for 7 days during a transition to CAB-LA
  • For LEN PrEP continue with the daily Oral PrEP dose throughout both days of LEN initiation regimen .

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Switching From the Dapivirine Vaginal Ring (DVR)�

  • Step 1: Confirm eligibility
  • Before switching, assess whether the client is eligible for the new PrEP option.
  • Step 2: Maintain the DVR during transition

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When switching from DVR to:�

  • To CAB-LA Injection 1:�Continue wearing the DVR for 7 days after CAB-LA Initiation Injection 1.

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To oral PrEP:

  • Continue wearing the DVR for 7 days after starting oral PrEP.

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Switching from DVR to

  • LEN:�Keep the DVR in place during both days of the LEN initiation regimen.
  • Do not remove the DVR too early. Keep it in place for the recommended transition period to maintain HIV protection

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Switching From CAB-LA to Another PrEP Product�

  • Clients using CAB-LA may switch to another PrEP option if clinically eligible.
  • The transition should be planned according to when CAB-LA coverage is expected to wane.

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Timing

Start the new PrEP option:

  • 1 month after Injection 1, or
  • 2 months after Injection 2 or any follow-up injection.
  • Possible options include:
    • DVR
    • LEN initiation regimen
    • Oral PrEP

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Transition to oral PrEP

  • Switching is allowed if clinically eligible for a new product
  • Start the Oral PrEP product as CAB-LA coverage wanes:
  • 1 month after Injection 1, or
  • 2 months after Injection 2 or any follow-up injection.�

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Transition to DVR

  • Switching is allowed if clinically eligible for a new product
  • Insert DVR product as CAB-LA coverage wanes:
  • 1 month after Injection 1, or
  • 2 months after Injection 2 or any follow-up injection.�

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Transition to LEN

  • Switching is allowed if clinically eligible for a new product
  • Start LEN injection as CAB-LA coverage wanes:
  • 1 month after Injection 1, or
  • 2 months after Injection 2 or any follow-up injection.�

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Switching From LEN�

  • Clients receiving LEN injectable PrEP may switch to another PrEP product if clinically eligible.

Transition timing

  • Begin the new PrEP product 6 months (26 weeks) after the last LEN injection.
  • Possible options include:
      • DVR
      • CAB-LA
      • Oral PrEP

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Transition to oral PrEP

  • Clients may switch if clinically eligible.
  • Begin the Oral PrEP product 6 months after the last LEN injection.
  • Plan the transition in advance to ensure continuous HIV prevention.

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Transition to DVR

  • Clients may switch if clinically eligible.
  • Begin the DVR 6 months after the last LEN injection.

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Transition to CAB-LA

  • Clients may switch if clinically eligible.
  • Start CAB-LA 6 months after the last LEN injection.
  • Plan the transition in advance to ensure continuous HIV prevention.

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Common Pitfalls to Discuss�

  • During the session, emphasize common errors that can result in inadequate prevention:
    • Stopping the current PrEP product too early
    • Starting the new product too late
    • Failure to confirm clinical eligibility
    • Failure to check HIV status according to protocol
    • Poor understanding of overlap periods
    • Incorrect dosing
    • Failure to document the transition
    • Not explaining the transition clearly to the client
    • Failure to plan for the next injection or product
    • Assuming that all PrEP products have the same transition requirements

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Scenario 1

  • Mary, a 27-year-old , comes for her routine immunization visit for her baby who is 10 weeks old. She is currently taking TDF-based oral PrEP but finds daily pill-taking inconvenient and would like to switch to CAB-LA.

Questions

  • What should you assess before switching?
  • When should CAB-LA be initiated?
  • How long should the client continue oral PrEP after Injection 1?

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Scenario 2

  • Grace 28 years old, is 24 weeks pregnant and has been using injectable lenacapavir (LEN) PrEP for HIV prevention. During her routine ANC visit, she tells the healthcare worker that she would prefer to switch from LEN to daily oral TDF-based PrEP because she is more comfortable taking a tablet and would like to avoid further injections during pregnancy.

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Discussion questions:

    • What should the healthcare worker assess before switching Mary from LEN to oral PrEP?
    • What counseling should Mary receive about the switch?
    • How should continuity of HIV protection be maintained during the transition?

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