The number of hiv infections is only slowly diminishing in the Netherlands. Despite various efforts, there are still more than 800 new hiv infections every year. PrEP contributes to the reduction of the transfer of hiv and helps to bring down the number of infections.
PrEP is the abbreviation for Pre Exposure Prophylaxis. It is a means of prevention; a tablet to prevent you acquiring an hiv infection. It consists of two active ingredients, emtricitabine and tenofir desoproxil, agents that are also used as hiv inhibitors. The safety and efficacy of PrEP have been proven and the efficacy and good treatment adherence have been proven in various studies.
Good (medical) support is necessary to guarantee safe use, to prevent resistance being built up and to promote adherence to therapy. Persons using PrEP come in before starting PrEP, one month after starting and then every three months for a follow-up. Counselling takes place with regard to adherence to treatment and risk reduction. Lab checks are also performed according to the national multidisciplinary guideline.
Every doctor can prescribe PrEP. PrEP is only available by prescription in the Dutch pharmacies. The minister of Health and Welfare decided in June 2018 that PrEP will be provided to people who run a high risk of hiv. The actual provision should start in 2019, however there is much uncertainty about this.
The Hiv Treatment centre finds that PrEP use must be well-registered and assured and needs careful medical support. This is, however, a new prevention strategy that may have effects on the hiv epidemic. An additional advantage of PrEP is that, from our own experience, we have noted that PrEP use reduces the fear of hiv and positively influences the experience of sexuality.
Nonetheless, it appears that the execution of the ministerial decree will require a wait for now. In practice this means that only a number of municipal health services provide PrEP care and a few general practitioners are promoting it. Therefore, the Hiv Treatment centre has decided to offer PrEP care.
With a referral from the general practitioner, anyone who qualifies can make an appointment with us. During the first visit, we will provide a detailed explanation about taking PrEP and the effects as well as about side effects. We will do the necessary tests before you start PrEP and provide support after starting. The prescription for PrEP can be picked up at any pharmacy. Where possible, the care will be transferred back to the general practitioner after a few months.
Your excess applies with a referral from the general practitioner. In addition, the PrEP medication itself is not currently reimbursed by health insurance providers. The average price is about 40 euros per month for daily use.