Emergency Department Management of Body‐Fluid Exposures Receiving Human Immunodeficiency Virus Post‐Exposure Prophylaxis: Adherence to Australian Guideline Recommendations

OBJECTIVE: To evaluate documented adherence to Australian guideline recommendations for emergency department (ED) management of patients receiving human immunodeficiency virus post-exposure prophylaxis (HIV PEP) and explore variation by exposure category. METHODS: A retrospective, dual-site cohort study included consecutive patients dispensed HIV PEP at two Australian EDs between 1 June 2020 and 1 June 2025. Patients with known HIV infection or managed through a dedicated sexual assault pathway were excluded. Records were reviewed for documented exposure-risk assessment, applicable baseline investigations, antiretroviral regimen, counselling, discharge information and clinician-documented follow-up plan or referral. Exploratory comparisons were undertaken by exposure category. RESULTS: Seventy-seven patients were included. Clinician documented follow-up plan or referral was documented in 73 (94.8%), and 61 (79.2%) received the first-line regimen recommended by the applicable guidance. Complete recommended management was documented in 8 (10.4%), exposure-risk assessment in 36 (46.8%) and complete baseline investigations in 10 (13.0%). Compared with occupational and other community exposures, consensual sexual exposures had lower documented exposure-risk assessment (36.2% vs. 78.9%; OR: 0.16, 95% CI: 0.03-0.57) and complete baseline investigations (5.2% vs. 36.8%; OR: 0.10, 95% CI: 0.01-0.50). CONCLUSIONS: Among patients dispensed HIV PEP, recommended regimens and follow-up were commonly documented, but complete recommended assessment and investigation were uncommon. A structured ED body-fluid exposure pathway should be prospectively evaluated.