East Bay Getting to Zero
Clinical Guides, PrEP, Prevention

Now there is a buffet of HIV medical prevention options, including PIP: PEP-in-Pocket!

From Bogoch et al, IDWeek 2023

PIP = HIV Post-Exposure Prophylaxis (PEP)-in-Pocket

  • What PIP is: Providing a HIV post-exposure prophylaxis (PEP) prescription (28-days) for HIV-negative people who have 0-4 high risk HIV exposures per year. Patients are seen every 4-6 months for HIV/STI screening and to re-evaluate exposures and discuss which HIV prevention method currently works best for them (PIP, PrEP, condoms).
  • Evidence: Updated data for this PIP study presented at IDweek in October 2023 showed that of the 69 courses of PIP initiated, there were 0 (zero) HIV seroconversions. PIP is 43% less costly than PrEP.
  • PIP regimens used: Biktarvy and TDF/F+DTG (Truvada with Tivicay). 2024 CROI update: a prospective study using Biktarvy as PEP in 119 people found high tolerability, high adherence, and no seroconversions, which matches previously published data on Biktarvy for PEP.  
  • Difference between PIP and doxy-PEP: Doxy-PEP is for STI prevention whereas PIP is for HIV prevention. Both are post-exposure prophylaxis on-hand (prescribed before exposures) and should be taken within 72 hours after exposures.
  • Difference between PIP, PrEP 2-1-1 and daily/injectable PrEP:
    • PIP is intended for people with fewer HIV exposures (0-4 per year).
    • PrEP 2-1-1 can also be for people with fewer HIV exposures but needs to be started 2- 24 hours before exposures and is only proven for condomless anal sex among MSM.
    • Daily/injectable PrEP is for people with more frequent HIV exposures and can take daily medications or come in every 2 months for injections.
    • Patients can toggle between PIP, 2-1-1 PrEP and daily/injectable PrEP depending on their current exposure risks and medication preferences. 
    • For patients on PrEP, consider prescribing PIP as a backup self-initiated prevention method.
  • How to offer PIP: please see the graphic below for the recommended process from the PIP study authors. For more details, download their PIP Provider Toolkit.  

PIP resources