O6.1 - High uptake of Doxycycline for STI prevention (doxy-PEP) among individuals using HIV PrEP at a municipal sexual health clinic in San Francisco, California
Background: Doxycycline 200mg taken within 24-72 hours of condomless oral or anal sex (doxy-PEP) reduces the risk of chlamydia, gonorrhea, or syphilis acquisition in MSM and transgender women (TGW) on HIV PrEP or living with HIV. We describe early implementation and uptake of doxy-PEP at a public STI clinic.
Methods: Starting 11/3/2022, persons receiving HIV PrEP at San Francisco City Clinic were systematically offered doxy-PEP according to SFDPH interim guidelines: doxy-PEP was recommended for cis MSM and TGW who have sex with cis men (TWSM) reporting condomless anal or oral sex with ³1 cis male or trans female partner and diagnosed with ³1 bacterial STI in the past year (Tier 1), and was offered to MSM and trans persons reporting multiple cis male or trans female partners in the last year without a bacterial STI (Tier 2). Patients not receiving PrEP at SFCC were offered PrEP during clinician visits using the same guidelines. We analyzed characteristics of those initiating doxy-PEP between 11/3/22 and 1/6/23 and bivariate associations between covariates and doxy-PEP uptake for patients on PrEP who met Tier 1 or Tier 2 doxy-PEP eligibility criteria.
Results: Overall, 312 persons started doxy-PEP, of whom 94% were cis MSM and 4% were TWSM. 37% were White, 31% Hispanic, 15% Asian/Pacific Islander, 10% Other, and 6% Black. 90% were HIV-negative on PrEP. In the prior 3 months, 48% reported 2-5 sex partners; 40% reported >6 partners; 35% reported any CT (20%), GC (20%), or syphilis (5%); and 9% reported multiple STIs. The majority (58%) met criteria for Tier 1. Among PrEP patients, doxy-PEP uptake was higher in Tier 1 (58%) vs Tier 2 (49%). Doxy-PEP uptake was not associated with age, sex/gender, race/ethnicity, or STI in the prior 3 months in either tier. Uptake was significantly lower among Tier 2 patients with only 1 vs >1 partner in the prior 3 months (p=.003), but not among Tier 1 patients.
Conclusion: Uptake of doxy-PEP was high regardless of age, race/ethnicity, and partner history among patients on PrEP at a municipal STI clinic and was highest among those with an STI in the prior 12 months.
