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Stakeholder perspectives on integrating doxycycline postexposure prophylaxis into Kenyan HIV PrEP programmes
Felix Ong'era Mogaka1, Benn Kwach2, Alfred Odira2
1Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya fmogaka@kemri-rctp.org.
Sexually Transmitted Infections
|July 8, 2025
Summary
Doxycycline postexposure prophylaxis (doxyPEP) is an acceptable and feasible strategy for sexually transmitted infection (STI) prevention in Kenya. Sustainability requires addressing antimicrobial resistance, pill burden, and provider workload.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Implementation Science
Background:
- Doxycycline postexposure prophylaxis (doxyPEP) is an effective strategy for preventing sexually transmitted infections (STIs).
- Current implementation guidelines suggest focusing on individuals with prior STIs or those on HIV pre-exposure prophylaxis (PrEP), but robust trial data is needed for broader adoption.
- Limited research exists on implementing doxyPEP in resource-limited settings.
Purpose of the Study:
- To explore potential barriers and facilitators for implementing doxyPEP in resource-limited settings.
- To assess the acceptability, feasibility, and sustainability of integrating doxyPEP into existing HIV PrEP programs in Kenya.
Main Methods:
- A qualitative study utilizing semistructured interviews with policymakers, healthcare providers, and HIV PrEP users in Kenya.
- Interviews were recorded, transcribed, translated, and analyzed using deductive reasoning based on the Consolidated Framework for Implementation Research.
- Data collection occurred between August 2022 and April 2023, involving 40 participants.
Main Results:
- Participants found doxyPEP acceptable and understood its utility for STI prevention among HIV PrEP users.
- Feasibility of integration was recognized, but concerns were raised regarding long-term sustainability, antimicrobial resistance (AMR), cost, pill burden, and provider workload.
- Key factors for sustainable implementation include addressing costs, external policies, incentives, and engaging all stakeholders.
Conclusions:
- DoxyPEP is perceived as acceptable and feasible for STI prevention in Kenya when local contextual factors are considered.
- Sustainability hinges on proactively addressing concerns such as AMR, pill burden, and increased healthcare provider workload.
- Successful integration requires careful planning to mitigate potential challenges and ensure long-term program viability.
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