Background:  We describe national post-exposure prophylaxis (PEP-HIV) guidelines in developing countries.

Methods:  A questionnaire was piloted and sent to World Health Organization country offices enquiring about national PEP-HIV recommendations. Topics included information about when to use PEP-HIV, eligibility criteria, when to start and stop, recommended drugs, and operational aspects.

Results:  Questionnaires were obtained from 41 countries, 40 (98%) of which had developed national PEP-HIV guidelines; 29 countries (72%) had applied PEP-HIV guidelines to occupational and non-occupational situations and 11 countries (28%) only for occupational situations. Only 14 countries (35%) had developed specific recommendations for children. All 40 countries recommended the use of PEP-HIV for needle-stick injuries or other potentially contaminated medical instruments, 37 (93%) recommended PEP for accidental mucosal exposures, and 28 (70%) for rape; 36 countries (90%) recommended to starting PEP-HIV within a specific time limit, 6 (15%) <24 hours, 8 (20%) <48 hours, and 19 (48%) between 48 and 72 hours after exposure. Only 7 countries (18%) recommended considering the estimated HIV prevalence. Of the 40 countries, 38 (95%) recommended HIV testing of the exposed person and 24 (60%) of the source person. In terms of regimens, 24 countries (60%) recommended dual or triple combinations, 16 (40%) recommended the use of only triple therapy for PEP-HIV; 1 country recommended only dual therapy; 22 countries (60%) recommended zidovudine plus lamivudine (AZT+3TC), 21 (57%) recommended AZT+3TC+ nelfinavir (NFV), 20 (54%) AZT+3TC+ indinavir (IDV), and 17 (46%) recommended AZT+3TC+lopinavir/ritonavir (LPV/r). As for duration of PEP-HIV, 34 countries (85%) recommended 4 weeks. In 17 countries (43%), a national register or reporting system for PEP-HIV exists, while 20 countries (50%) reported that PEP-HIV guidelines were included in their national HIV strategic plans, 32 countries (80%) reported that PEP-HIV issues were part of the national HIV training plan, and 20 countries (50%) reported that PEP-HIV issues were part of national occupational health programs.

Conclusions:  Most countries had developed national PEP-HIV recommendations for different situations. These findings provided useful feedback for the development of internationally agreed PEP-HIV guidelines. However, some issues still need to be adequately addressed as specific operational aspects, whether countries should recommend the use of dual- or triple-drug regimens and the establishment of PEP recommendations for children.