Similarity Between Guidelines for Post-Exposure Prophylaxis for Hiv Risk: A Multinational Study

Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) risk is widely adopted as a prevention strategy, but clinical guidelines vary across countries. Assessing alignment between protocols allows reflection on the feasibility of international consensus around PEP. The aim of this study was to analyze the degree of convergence between clinical guidelines for HIV PEP management, based on their technical and operational content. Descriptive-comparative study with systematized and nonsystematized searches conducted in January 2025 in PubMed, Web of Science, DOAJ, ScienceDirect, the Virtual Health Library and official websites. Guidelines published from 2015 to 2024 in Portuguese, English, or Spanish were included. Recommendations were organized into a binary matrix with eight thematic axes, and similarity between documents was evaluated by hierarchical clustering (Ward’s method, Jaccard distance) using SPSS v.29. Similarity was classified as high (≥ 80%), moderate (50–79%) or low (< 50%), according to the proportion of guidelines with similar recommendations in each axis. Nine guidelines were analyzed: World Health Organization (2018), United States Centers for Disease Control and Prevention (CDC, 2016), United Kingdom (2021), Canada (2017 and 2023), Brazil (2023), Australia (2023), South Africa (2015), and El Salvador (2022). There was complete convergence regarding PEP initiation within 72 hours and 28-day duration (100%), and high convergence in recommending three antiretrovirals (89%), one of them an integrase inhibitor, and in initial HIV testing (100%). Most guidelines also recommended transition to PrEP (89%) and testing for hepatitis and other sexually transmitted infections (67%). Conversely, there was low convergence in approaches to specific populations (44%), in the level of detail for clinical follow-up (33%), and in how PEP provision is organized (33%), including access points, type of prescribing professional, and service coverage. As a limitation, the absence of guidelines from Middle Eastern and Asian countries restricts the global representativeness of the findings. The guidelines analyzed show strong alignment in core elements of PEP, such as timing of initiation, duration, and medication regimen. However, structural differences persist in how subgroups are approached and in the care delivery models adopted, which may pose challenges to a global standardization.