First guidance for prescribing post-exposure HIV prevention
05 Aug 2025
Australian-first clinical guidance on prescribing post-exposure prophylaxis has been launched, helping GPs in their role of HIV prevention.
While post-exposure prophylaxis (PEP) plays an important role in HIV prevention after an individual is potentially placed at risk of transmission, the treatment is most effective if started within three days of exposure.
To help ensure treatment is given in a timely manner, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) has developed the first clinical decision-making tool specific to Australia to support GPs to prescribe HIV PEP to prevent transmission.
A two-page resource, Decision making in HIV PEP, provides guidance on appropriate procedures and suitability of PEP treatment, including HIV risk assessment and the steps prior to commencing a patient on PEP.
It also outlines when the treatment is not recommended, such as for any sexual exposure with a person living with HIV with undetectable viral load (U=U).
Given as a daily course of antiretroviral drugs for 28 days to reduce the risk of acquiring HIV following exposure, PEP treatment is recommended to be given within 72 hours to be most effective.
However, ASHM states ‘the earlier it is initiated after exposure the better’ and each presentation should be assessed on a case-by-case basis to determine risks and benefits.
Chair of RACGP Specific Interests Sexual Health Medicine Dr Sara Whitburn told newsGP the tool is a clear and easy-to-use addition for GPs providing timely care in this space.
‘It’s a supportive tool to add to our discussions about safer sex and HIV prevention, especially when initiating PEP, as assessing if someone has had recent exposure, advising or providing PEP if they have been exposed in last 72 hours may be the most appropriate treatment,’ she said.
‘Being able to discuss and inform someone about their HIV exposure risk, and if they are recommended for PEP or not, supports our patient’s decision making and can be reassuring if PEP is not recommended. It also helps with discussion about accessing PEP if someone is at high risk.
‘If someone has ongoing risks for HIV exposure after the 28 days of PEP then GPs can continue the medication which helps with prevention and access.
‘Being able to provide advice in primary care supports patients to get information and PEP in a timely manner.’
ASHM also notes that presenting for PEP treatment and disclosing HIV-risk behaviour can be a stressful experience for patients and negative experiences can result in failure to re-present for treatment, leading to potential subsequent HIV transmission.
Clinical Professor Louise Owen was involved in developing the ASHM decision-making tool. She told newsGP that GPs have a ‘crucial role’ in prescribing PEP and conducting non-judgemental assessments.
‘GPs are often the first point of contact for patients in this situation, so having a tool to quickly assess the risk and prescribe medication if needed will be highly beneficial,’ she said.
‘The decision-making tool provides a comprehensive, evidence-based approach with a clear, step-by-step framework to guide GPs through the PEP process.’
The release of the tool comes as Australia approaches the 2030 goal of virtual HIV elimination under its national strategy, with pre-exposure prophylaxis (PrEP) hailed as a ‘game changer’ in HIV prevention since it became available on the PBS in 2018.
While PrEP is a proactive, ongoing prevention method for individuals at high risk, Professor Owen says PEP is ‘an emergency measure’ taken after a potential exposure.
Unlike PrEP, there is no current PBS listing for PEP, but all GPs can prescribe generic 2-drug PEP on private prescription, which the tool advises GPs on.
The ASHM resource recommends, in addition to ordering baseline pathology for all patients presenting for PEP, that GPs ‘strongly encourage’ transition directly to PrEP after completing the PEP course, where there are ‘likely to be ongoing HIV exposures and/or there have been multiple previous PEP courses’.
In her clinic, Dr Whitburn has a ‘small but growing number’ of patients asking about HIV PEP, and points to after-hours resources also available for patients.
‘Discussing HIV risks and prevention is part of my practice when offering asymptomatic STI testing, managing positive STI results and in PrEP consultations,’ she said.
‘I am a S100 prescriber so I can [also] discuss 3-drug PEP, but this tool is helpful to support GPs to have discussions about PEP and support patients even if they refer to other centres providing PEP.’
The new clinical tool accompanies ASHM’s Australian National Guidelines for Post-Exposure Prophylaxis (PEP) after Non-Occupational and Occupational Exposure to HIV, with the latest edition including up-to-date and evidence-based recommendations on prescribing PEP, including:
- inclusive, culturally safe, and appropriate language when consulting with patients
- considerations around affordable options and access to HIV PEP
- GP prescribing of HIV PEP
- advice for patients who have missed doses or have additional exposures while on PEP
- shared decision-making with patients about reducing on-going exposure risks.
S100 training for GPs to provide HIV treatment including 3-drug PEP is available through ASHM.