Stakeholder perspectives on integrating doxycycline postexposure prophylaxis into Kenyan HIV PrEP programmes

Doxycycline postexposure prophylaxis (doxyPEP) is an efficacious sexually transmitted infection (STI) prevention strategy. Implementation guidelines recommend a focus on people with prior STIs and/or those taking HIV pre-exposure prophylaxis (PrEP), but trial results are insufficient for interventions to enter guidelines and clinical practice. The purpose of this paper is to describe potential barriers and facilitators for successful implementation strategies of doxyPEP in resource-limited settings.

This qualitative study explored the perceived acceptability, feasibility and sustainability of integrating doxyPEP for STI prevention into Kenyan HIV PrEP programmes. Semistructured interviews were conducted with policymakers, healthcare providers and HIV PrEP users. The interviews were recorded, transcribed and translated to English. Analysis was completed using Dedoose software using deductive reasoning based on the Consolidated Framework for Implementation Research.

Forty interviews (7 policymakers, 16 HIV PrEP users, 17 healthcare providers) were conducted between August 2022 and April 2023. Collectively, study participants found doxyPEP to be an acceptable strategy and understood its potential use among HIV PrEP users. However, participants noted several considerations such as the relative advantage, quality and evidence strength, and tension for change alongside the needs, resources and knowledge of the recipient. Integrating doxyPEP into HIV PrEP programmes was deemed feasible, but there were concerns over long-term sustainability, antimicrobial resistance (AMR), surveillance, cost, pill burden and compatibility, and high workload for HIV PrEP providers. Establishing sustainable practice needs to consider costs, external policies, incentives to participate and engaging providers and recipients in the process.

Kenyan HIV/STI policymakers, healthcare providers and HIV PrEP users perceived doxyPEP for STI prevention to be acceptable and feasible when addressing local contextual factors. Potential for sustainability was recognised if programmes can address concerns, including AMR, pill burden and additional workload for health professionals, prior to the implementation of doxyPEP into HIV PrEP programmes.