So you've discussed the use of PrEP On-Demand (PrOD) with your provider. As indicated, this is not officially approved by Health Canada but multiple studies show it is an effective way to use PrEP. It is only effective if used correctly.
What is PrEP On-Demand (PrOD)?
PrOD is an alternative to daily PrEP that involves taking the medication before and after sex. It can be useful if you know in advance when you’ll be having sex, and if you’re having sex infrequently. Recent research shows that it may be as effective as daily PrEP in preventing HIV.
How do I take PrOD?
PrOD follows a dose schedule known as 2-1-1. This is:
- 2 pills before sex (2-24 hours in advance)
- 1 pill 24 hours after the first doses
- 1 pill 24 hours after the second dose
If you have sex again, you can keep adding doses at 24 hour intervals. You need to keep taking PrEP for two days (i.e. two doses) after the last time you had sex.
As an example, if you were planning to have sex on Saturday night you would take two PrEP pills on Saturday morning, another on Sunday morning and another on Monday morning. If you had sex again on Sunday, you would take PrEP on Monday and Tuesday morning. Your schedule would look like this:
Saturday morning: PrEP x 2
Saturday evening: sex
Sunday morning: PrEP
Sunday evening: sex
Monday morning: PrEP
Tuesday morning: PrEP
If you'd like to continue with daily PrEP after completing this schedule, you can.
Can I use Descovy for PrOD?
PrOD has only been studied with Truvada and its generic versions. This means that it is only proven effective with these medications. While Descovy is a similar drug and may have similar effects, this has not been confirmed through research and Freddie cannot recommend Descovy for this purpose.
I am on PrOD. Do I still need to complete routine testing?
Yes, routine lab testing for this medication is still required every three months, even if you do not need a refill. We adhere to the Canadian guidelines for prescribing PrEP, and this regular testing is necessary to ensure that PrEP remains a safe medication for you.
How do I switch from daily PrEP to PrOD?
If you are thinking of switching from daily PrEP to PrOD, we ask that you book in for a follow-up appointment with your clinician to discuss, prior to making any changes to your regimen.
Who shouldn’t use PrOD?
PrOD shouldn’t be used if you don’t know when you’ll be having sex. Daily PrEP is a better alternative that gives you ongoing protection.
PrOD is also only studied in cis men and trans women, and is only confirmed to provide protection for anal sex. It should not be used by anyone having vaginal sex. This includes cis women, trans men and trans women who've had vaginoplasty. This is because it takes PrEP longer to reach optimal levels in vaginal tissue.
PrOD hasn’t been studied among people who inject drugs, so you shouldn’t use this method if this applies to you.
What if I can’t afford daily PrEP?
Some people choose PrOD because they might have financial issues or challenges accessing a stable PrEP supply. If this applies to you, then Freddie might be able to help you get daily PrEP. We can connect you with provincial drug plans and also may be able to offer our own financial assistance program, along with emergency PrEP supplies while you wait for these to process.
Have additional questions?
Because PrOD can be a complicated topic, you can book a free follow-up consult with us anytime so we can fully address any other questions or concerns you have.