Merchant and colleagues report an audit of adherence in their paediatric emergency department to the New York State Department of Health guidelines on HIV post-exposure prophylaxis (PEP).¹ The guidelines recommend that every victim of unprotected vaginal or anal rape presenting within 36 hours should receive HIV PEP unless the assailant is known to be HIV negative. Where possible, they should receive treatment within one hour of assault. Over six months, 14 of 25 patients received HIV PEP. No patient presented within one hour. Even after presentation, the minimum triage to medication time was two hours. The authors suggest strategies to speed the delivery of prophylaxis.

Many of the important questions come well before an audit of adherence to guidelines. …