Facilitators and Barriers to the Rollout of Doxycycline Postexposure Prophylaxis for Sexually Transmitted Infections...

Doxycycline postexposure prophylaxis (doxyPEP) is a promising strategy to prevent bacterial sexually transmitted infections. Limited data exist evaluating patient and provider experiences since doxyPEP has become widely available. We aimed to explore such factors among providers and patients during real-world implementation within one community health center.

Doxycycline postexposure prophylaxis was rolled out at Fenway Health on February 2, 2023. To support rollout, electronic health record tools, 3 provider training sessions, and a community town hall were developed and implemented. All providers who participated in doxyPEP trainings were surveyed as well as patients with evidence of a doxyPEP discussion during a clinic encounter who were retrospectively identified via chart review.

Between rollout and September 3, 2024, there were 3770 doxyPEP prescriptions. Among 45 providers, the median score of comfort having conversations about doxyPEP increased from 78 (interquartile range, 52-100) out of 100 after the second training to 100 (interquartile range, 88-100) after the third training. Of 150 patient responses, 90 (60.0%) were from individuals prescribed doxyPEP; reasons for use included sex with a random partner (65.6%) and condomless anal intercourse (63.3%). Among 60 patients not prescribed doxyPEP, 25 (41.7%) reported they did not feel it was warranted due to low perceived risk. Eleven (18.3%) reported they felt the risks outweighed the benefits.

Without national guidelines, the uptake of doxyPEP was robust, supported by electronic support tools and provider training sessions for clinicians, as well as community engagement efforts. Differences in risk perception were important factors in the choice to use doxyPEP.