Follow-up after PrEP initiation:

• Instruct patients to notify their care provider immediately if they experience adverse effects.
• Oral PrEP: Within 2 weeks, ensure that the patient has filled the PrEP prescription, understands how to take the medication, knows how to manage any adverse effects, and has identified and solved any problems with payment for PrEP.
• Injectable PrEP: Within 1 week of the first injection, assess for tolerability and injection site reactions.

At each visit [b]:

• Make every effort to avoid discontinuing PrEP or withholding it from a patient at risk of acquiring HIV.
• Inquire about adverse effects and offer advice for management if needed.
• Assess adherence, identify challenges, and discuss strategies for maintaining adherence.
• Schedule the next visit, arrange for confirmation and reminders, and individualize ongoing care and monitoring to meet the patient’s needs; explore alternative modalities such as telehealth visits and in-home testing.
• Offer contraception to individuals of childbearing potential who wish to avoid pregnancy while using PrEP.

Risk reduction:

• At each visit, discuss risk reduction as essential to sexual health; offer female/receptive or male/insertive condoms.
• For patients who inject drugs or misuse mood-altering drugs, refer for substance use treatment and mental health support as appropriate.
• Prescribe clean syringes and needles or refer to needle-exchange programs as indicated (see NYSDOH Expanded Syringe Access Program (ESAP): Overview of the Law and Regulations and Directory of New York State Syringe Exchange Programs).