The other half of PrEP: the quarterly appointment

The pill is the easy part. It sits next to your toothbrush, and after a few weeks you stop thinking about it. The other half of PrEP is in your calendar: an appointment roughly every three months, at your practice or a Checkpoint. It's the reason the protection stays reliable.

What happens there is no secret, but it's rarely explained. So here it is, step by step.

Why every three months

PrEP protects against HIV as long as you're HIV-negative. An unnoticed infection can't be adequately treated with the active ingredients in the PrEP pill, and the virus can develop resistance. That's why the next prescription usually requires a recent negative HIV test. The rhythm isn't bureaucracy. It's the safety line.

The second reason: PrEP doesn't protect against other sexually transmitted infections. Many of them cause no symptoms in the throat or rectum. If you only get tested when something burns, you miss a good share. The fixed appointment finds them before they spread further.

What happens at the visit

The process and order vary from practice to practice. The core is similar everywhere:

• HIV test. At every appointment, as the basis for the next prescription.
• Syphilis. Via a blood sample, usually in the same go.
• Chlamydia and gonorrhoea. Swabs from the throat and rectum, plus a urine sample. You often take the swabs yourself, in a few minutes and alone in a cubicle.
• Kidney function. Tenofovir, one of the active ingredients, is excreted via the kidneys. That's why creatinine is checked regularly. How often depends on age and previous results.
• Hepatitis. At the start, they check whether you're protected against hepatitis B. If not, you'll be advised to get vaccinated. Depending on your situation, hepatitis C is tested at intervals too.

There's also a short conversation: how's taking it going, has anything changed, do you need something different. It's also the right place for the questions you'd never ask anyone else. The people who work there have heard them all.

Daily or on-demand: the appointment stays

Whether you take PrEP daily or on-demand as agreed with your doctor makes little difference to the check-up rhythm. Even if you only use PrEP during certain phases, it's best not to skip the tests.

Pausing and restarting belong in the conversation, not in the drawer with the old pack. Before you restart, you need a new HIV test. And if you have chronic hepatitis B, only stop PrEP under medical supervision, because the active ingredients also work against the hepatitis B virus.

What it costs

Germany: Since September 2019, PrEP has been covered by statutory health insurance for people aged 16 and over with an increased risk of HIV. Counselling, check-ups and medication are covered; the usual prescription co-pay applies. It can be prescribed by doctors with the relevant qualification, and HIV specialist practices are set up for it. If you're privately insured, clarify reimbursement directly with your insurer.

Austria: Since April 2024, social insurance has contributed a subsidy towards the costs. The scheme was introduced for a limited period. The Aidshilfen know how to submit claims and what currently applies.

Switzerland: Since July 2024, basic insurance has covered PrEP including counselling and lab tests, provided your care runs through doctors in the SwissPrEPared programme. Deductible and co-payment apply as with any other treatment. Here too, the scheme was introduced for a limited period. Aids-Hilfe Schweiz and the Checkpoints know the current status.

So the appointment happens on its own

Missed appointments are almost always a calendar problem, not a willpower problem. A few habits do the work for you:

• Book the next appointment before you leave the practice.
• Set the reminder two weeks before the pack runs out, not on the last day.
• Pick fixed months, such as January, April, July and October. Then you don't have to count.
• Keep results and vaccinations in one place, so switching practices doesn't mean starting from zero.

In the end, the quarterly appointment is like PrEP itself: unspectacular as long as it's running. That's exactly where its value lies. Protection isn't a single moment. It's a rhythm you set yourself.

This article doesn't replace medical advice. For your personal situation, your PrEP practice, your local Aidshilfe or a Checkpoint are the right people to talk to.