1. Home
  2. PrEP
  3. How it works

How SH.UK's PrEP service works

Introduction to SH:UK Digital-PrEP (D-PrEP)

Welcome to SH:UK D-PrEP. Accessing HIV PrEP with us aims to support you in self-managing your PrEP needs rather than attending clinic. This page provides an overview and advice on using the SH:UK D-PrEP service.


How do I know if you offer D-PrEP in my area?

We offer SH:UK D-PrEP across various Local Authorities across England where we have been locally commissioned. To see if we offer this service in your area enter your postcode in the SH:UK site.
If we do offer PrEP in your area, you will see a Preventx PrEP Service logo (showing your area), example:



If a logo like the one above DOES NOT appear, we do NOT offer PrEP in your area. If we do not offer D-PrEP in your area, please check your local sexual health clinic’s website to see how to access PrEP.


What is PrEP

PrEP stands for Pre-Exposure Prophylaxis. This means it is a prevention medication that needs to be taken before any sexual contact to stop HIV transmission.

PrEP is used for those who are HIV negative and may be at higher risk of getting HIV

PrEP will not prevent other sexually transmitted infections or pregnancy.

It is one tablet containing two different medications:

  • Most commonly emtricitabine and tenofovir disoproxil, which are more commonly referred to as generic, TDF (technically TDF /FTC) or Truvada®.
  • Alternative is emtricitabine and tenofovir alafenamide, which can often be called TAF (technically TAF/FTC) or Descovy®; this is not currently available through SH:UK.

How PrEP works to prevent HIV

When HIV enters the body, it gets into our cells and starts to multiply causing the virus level to rise in our blood and tissues.

PrEP creates a barrier so that if HIV tries to infect you it is blocked from replicating. If HIV can’t multiply inside your body, it can’t cause infection, and you remain HIV negative.

If you do not take PrEP medication correctly the drug levels might be too low to protect you. If this happens, you could become HIV positive. So, it is important to take PrEP correctly.


Treatment plans for PrEP

Generally, there are two ways to take PrEP – either event-based (on-demand) dosing or daily dosing.

Event-based dosing

Anal sex (giving & receiving) & giving vaginal/ frontal sex:

  • 2 tablets together (double dose) 2-24 hours before planned sex
  • Then 1 tablet each day having sex (if having sex more than 1 day)
  • Then 1 tablet each day for 2 days after the last sex has finished

Receiving vaginal / frontal sex

  • 2 tablets together (double dose) 2-24 hours before planned sex
  • Then 1 tablet each day having sex (if having sex more than 1 day)
  • Then 1 tablet each day for 7 days after the last sex has finished

Further information here: PrEP treatment plans


Daily - suitable for any type of sex

In daily dosing, PrEP medication is taken every day at around the same time. This gives protection against HIV for those that have any kind of sexual contact, giving peace of mind that you are always protected. You usually start with 2 tablets together (double dose) on the first day; you are then protected after 2 hours. You then continue daily with 1 single tablet each day.


Stopping or taking a break from daily dosing

If you want to stop or take a break from daily dosing it is important you continue to take PrEP for several days after your last condomless sex to ensure you are protected against HIV.

If you are having anal sex (giving or receiving) or if you give vaginal/ frontal sex, then you should take PrEP for 2 days after the last sex.

If you are receiving vaginal/ frontal sex, then you should take PrEP for 7 days after the last sex.


Cautions and side effects

PrEP is a very safe drug to take, but like all drugs some people need to be more cautious when taking it if they have certain medical conditions, are on specific medications or have allergies to the ingredients.


Medical conditions

Please let the clinical team know if you have any medical condition, especially if you have any of the following :

  • High blood pressure (hypertension)
  • Diabetes
  • Current or previous Hepatitis B or C
  • Problems with your liver or kidneys
  • Osteoporosis or bone health problems
  • Any conditions that reduce your immune system.

Medications

Please let us know if you are taking any medications from your doctor, pharmacy or online – we will check whether there are any expected drug interactions with your PrEP.
We advise that you avoid regular non-steroidal anti-inflammatory drugs like ibuprofen when taking PrEP.


Side effects

Some people may experience some side effects when they take oral PrEP. These are more common when you first start using PrEP but they usually reduce the longer you take it. The most common ones include:

  • Headache
  • Dizziness
  • Feeling sick or bloated
  • Stomach upset
  • Difficulty sleeping
  • Feeling more tired, lethargic or experiencing a lack of energy
  • Rash - If you develop a rash, please contact the clinical team

If you have any difficulty breathing, throat or tongue swelling or other severe reactions please seek urgent medical attention either through 111 or call 999 in an emergency.


Kidneys and bone health

There is a small potential that PrEP can cause problems for your kidneys. When taking PrEP we will monitor your kidney function tests – this should be every 3-, 6- or 12-monthly depending on your age and existing medical conditions. The kidney function test measures the level of creatinine in your blood. Creatinine is a waste product from the digestion of proteins and is removed from the blood by your kidneys. It’s normal for creatinine to be present in your blood but if the blood level is higher than normal it can be a sign of a kidney problem.

If you are aged over 40 and smoke, drink excessive alcohol or have certain pre-existing medical conditions there is also the possibility that PrEP use can impact on your bone health. A 3 yearly risk assessment should be undertaken when taking PrEP. If your risk of having a bone fracture is high, you should speak to your GP or local sexual health clinic for further assessment.


The SH:UK PrEP process

If you are brand new to SH:UK D-PrEP online we will ask you to complete an assessment.

The first online triage you do with us does involve answering a lot of questions, but you can do this in your own time, and it stops the need for a long phone consultation with us. If we need any further information, we will either message you via your online SH:UK account or call you to discuss it. You only need to complete this long form the first time – when ordering a repeat PrEP supply, we only ask a few questions to check nothing has changed since your last order.

If you are unable to fill in the questionnaire online and prefer to speak to someone, you can request a member of the clinical team call you. We can complete the assessment with you over the phone.

Before we can give you PrEP medication, we need to make sure you don’t currently have HIV or Hepatitis B and check your kidney function. After we have checked your triage forms, we will post out a blood testing kit for you to do at home. The tests are finger-pick blood tests for HIV,

Hepatitis, Syphilis and kidney function. We will ask you to repeat these blood tests 3 months later to check there is no new infection and that PrEP hasn’t impacted on your kidney function.


Important points on blood test kits:

  • We cannot offer routine PrEP medication until we have your initial blood test results. We recommend returning your blood samples as soon as you can or contacting our clinical team if you need support. Further advice on how to take the samples can be found here: Finger Prick Blood Test Kit | How to take your sample — SH.UK
  • For follow-up PrEP requests, if our clinical team post you a kidney function blood test, we need this result back before we can offer further PrEP treatment. Depending on your age and existing medical conditions we may need a kidney function test every 3-, 6- or 12months. We recommend STI and HIV testing every 3 months while using PrEP.
  • If you are provided with 2 separate blood testing kits, do not mix up the samples and the lab forms. We can’t test your blood if the lab form does not match the sample. There is a ‘PX’ code on the form that matches the ‘PX’ code on the sample label.
  • If you posted your blood samples more than 10 days ago and haven’t heard from us, please contact the clinical team through the ‘Account> My Message’ function in your SH.UK PrEP account.

The clinical team will contact you if there are any issues with your blood results.


PrEP treatment offer

Once we have all of your tests back, if they are all okay, we will then offer your PrEP medication through your SH:UK account.
Log into your SH:UK account, navigate to ‘Treatment’ and accept the treatment offer.
You will be taken to Lloyds Pharmacy Online Doctor (LPOD) service. There will be a very short questionnaire to confirm your medical history. LPOD will post your PrEP medication, usually within the next 1 to 2 working days.
If LPOD needs to check anything with you they will message you through your SH:UK account. To contact LPOD, log-in to your SH:UK account, go to ‘Treatment’, select your most recent treatment offer.
When in the treatment offer, click on ‘Contact us’. You can then send messages to and from LPOD.


First month check in
You are welcome to contact the clinical team if you have any issues with your PrEP ordered through SH:UK. After the first month we will send out a message to check in with you. Please let us know if you have any issues with any of the following:

  • Not yet received your PrEP medication
  • Any problems taking your PrEP (e.g. side effects)
  • Are you remembering how to take it correctly?
  • Have you forgotten any doses that may have put you at risk of HIV?
  • Have you had any new medical conditions, medications or allergies since we last contacted you?
  • Do you have any questions or queries you would like to discuss with the clinical team?

You can contact the clinical team through your SH:UK PrEP account.


Notifications and PrEP self-management disclaimer

SH.UK will send out reminder notifications based on your recorded preferences by SMS or email. Notifications are related to returning blood samples; when we estimate that you will require further PrEP supplies; and reminders to undertake STI, HIV and Hepatitis B screening. We will send out 3 blood reminders and 2 treatment supply reminders.

If you change your mobile number or email address, it is important you update your details on your SH.UK account. As long as your new mobile number/ email is not already registered on another SH.UK account you can update these details in your SH.UK account yourself [Account>My Profile].

Depending on your SH.UK notification preferences and your mobile/ email provider, some notifications may not come through or go into your junk folder. SH.UK will not be monitoring notifications that are not going through. If you are not receiving notifications as expected please check your notification preferences in your SH.UK account profile or with your provider. You can contact us on [email protected] if you need further assistance with updating your details or with notifications.

Use of SH.UK's online PrEP services involves you self-managing your PrEP requirements with support from our clinical team. It is, therefore, very important that you monitor how much PrEP you have left and when you require a further supply. We may not be able to provide PrEP at short notice, as we may require blood results prior to issuing PrEP medication.

You can contact our clinical team if you have any questions or are running low on PrEP through the SH.UK messaging function or through our Service User Support Team on 03333444462 Monday to Friday 08:30am to 17:00PM.


Follow-up PrEP supplies

Once you are coming close to the end of your PrEP supply, we will send you a reminder to complete another follow-up triage.

Follow-up triages are much shorter and quicker than the initial one.

If you are running out of your current supply before you get your reminder you can request further PrEP supplies through the messenger function in SH:UK account.


Contact us

Once registered as a PrEP user, if you need any assistance from the clinical team log in to your SH:UK account and click on the ‘messages’ section. This will allow you to send your PrEP-related queries to us.

<

Reviewed by Adam Black on 14th Feb 2025.