HIV PrEP and PEP awareness and practices among emergency doctors in Gauteng province

Background: Emergency departments (EDs) are key settings for both occupational and non-occupational HIV prevention. While occupational post-exposure prophylaxis (PEP) is widely implemented, pre-exposure prophylaxis (PrEP) remains underutilised. Understanding clinicians’ knowledge, attitudes, and practices (KAP) is critical to strengthening ED-based HIV prevention. Objectives: To assess the KAP of ED doctors in Gauteng, South Africa, regarding HIV PrEP and PEP, and to identify barriers to their implementation. Method: A prospective, cross-sectional, questionnaire-based study was conducted between June and October 2024 across five university-affiliated adult EDs in Gauteng. A self-administered questionnaire assessed personal PEP experience, PrEP/PEP availability, knowledge, prescribing practices, and perceived barriers. Knowledge scores were compared across subgroups using t-tests and chi-square tests. Results: Of the 110 doctors recruited, 102 completed questionnaires. While 81.4% reported prior PEP use and demonstrated good knowledge of PEP (mean score 4.3/7), knowledge of PrEP was significantly lower (mean score 3.0/7; P < 0.00001). Only 27.5% had ever initiated PrEP, and just 13.7% routinely offered it to at-risk patients. Barriers to PrEP prescribing included lack of rapid HIV testing (59.1%), time constraints (59.1%), and perceived inappropriateness for ED settings (54.5%). Higher knowledge scores were associated with having an HIV diploma and prior PEP use. Conclusion: ED doctors demonstrated high familiarity and confidence in prescribing PEP, but poor knowledge and uptake of PrEP. Addressing knowledge gaps, ensuring resource availability, and integrating PrEP into ED protocols are necessary to enhance comprehensive HIV prevention in high-burden settings.