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Officials Encourage Non-Daily PrEP Strategy For Low-Risk People


The 2-1-1 strategy calls for two pills a couple hours before having sex, then one pill 24 hours later, and then one final pill. 

Since July 2012, the U.S. Food and Drug Administration has encouraged the daily use of Truvada as a HIV prevention strategy (i.e. PrEP). But these days, new strategies are emerging for those who’d rather not practice PrEP every day. 

While some at-risk communities are encouraged to take Truvada every day — like trans women, for example, since recent studies suggest that feminizing hormones could lead to Truvada filtering out of a person's system faster than those who aren’t on feminizing hormones — other low-risk communities have found ways of practicing PrEP. 

As reported by The Bay Area Reporter, San Francisco leaders are embracing a new dosing regimen that doesn't require continual usage of the drug.

Dubbed "PrEP 2-1-1" (named for it’s 2 pills, 1 pill, 1 pill strategy), its design is for those who are only intermittently sexually active, rather than those who have sex regularly. It requires a person to take two pills of Truvada at least two hours — but preferably 24 hours — prior to engaging in sex. They then take another pill 24 hours later, and if done having sex, a final pill another 24 hours after that.

The 2-1-1 strategy is particularly packaged for those going on vacation for at least a week, and plan to have sex during the entire time. These folks would continue to take one Truvada pill every day of their break. When done with their vacation, they would need to take one last dose of PrEP 48 hours after their last sexual encounter, The Bay Area Reporter further explained. 

"We think it's going to bring a whole lot of people to PrEP who previously did not feel like PrEP was for them," added Dr. Chris Hall, vice president of medical affairs at the San Francisco AIDS Foundation. 

The foundation is putting its theory to the test through a pilot study of PrEP 2-1-1 at Strut, a health center for men in the Castro. It is seen as a first step in providing data to the U.S. FDA in order to have the federal agency officially recommend PrEP 2-1-1.

The International AIDS Society-USA has already endorsed PrEP 2-1-1, as well as health officials in France, the United Kingdom, Canada, and Australia. Here in the U.S., it’s been difficult to estimate how many people are utilizing Truvada as PrEP due to a lack of coordinating a tracking system, but health officials believe it’s between 100,000 and 200,000 people. 

"So far we've ever really emphasized the use of PrEP everyday to keep HIV away, but 2-1-1 dosing is a different way," said PrEP expert Dr. Robert Grant of the UCSF-Gladstone Center for AIDS Research at the recent forum hosted at Strut. "2-1-1 dosing is on when you're having sex. Two pills before sex, one pill the day after sex, and a fourth pill two days after sex. It is used when you're having sex, and if you're not having sex then you don't take PrEP."

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