(P311) Post-exposure prophylaxis with doxycycline (doxyPEP) to prevent STIs among men who have sex with men in the United States is highly acceptable to health providers caring for MSM

Background: Post-exposure prophylaxis with doxycycline (doxyPEP) reduces the incidence of chlamydia (CT), gonorrhea (GC), and syphilis among men who have sex with men (MSM). After effectiveness of the DoxyPEP study was presented, we sought to understand health provider beliefs, practices, and willingness to prescribe doxyPEP to MSM as an STI prevention strategy.



Methods: We conducted in-depth interviews (IDI) among health providers (HPs) from 16 cities in regions of the US with the highest sexually transmitted infection (STI) rates. HPs (infectious disease, primary care physicians, nurse practitioners, physician assistants, pharmacists) who provide care to MSM patients were invited to participate via newsletters and emails. IDIs were conducted virtually via Zoom. Transcripts and debrief reports were analyzed thematically to explore beliefs and perceptions about doxyPEP for STI prevention.



Results: From September to December 2022, we conducted 29 IDIs (45% in the NE, 35% in the West, and 21% in the South) among providers --11 infectious disease, 13 primary care, 4 sexual health, and 1 pharmacist. 41% had panels of >100 MSM patients. Most HPs were aware of doxyPEP to reduce the risk of STIs, primarily from scientific conferences, webinars, and recent publications. HPs unfamiliar with doxyPEP were open to learning, especially if it would benefit their patients. Most HP attitudes toward doxyPEP were favorable, which they viewed as another ‘tool for the toolkit’ for patients at risk for multiple STIs. Most HPs felt doxyPEP would unlikely cause antimicrobial resistance (AMR). However, some reported concerns that patients would not take doxyPEP as directed and the potential for AMR. Most felt these concerns could be addressed with guidance on prescribing and care management. Specially, guidance from the CDC and more scientific data on long-term safety would influence HP's willingness to prescribe doxyPEP.



Conclusion: In this qualitative study, most HPs caring for MSM in the US were aware of doxyPEP’s effectiveness in reducing risk of STIs among MSM and acceptability was generally high. Data to inform which patients would benefit most from doxyPEP and long-term safety and AMR data would increase HPs willingness to prescribe doxyPEP.