Client Priorities for Improving PrEP and doxy-PEP Awareness, Uptake, and Persistence in Primary Care

Sexual and gender minorities (SGMs) remain disproportionately affected by HIV and bacterial sexually transmitted infections (STIs). Despite the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention and the emerging promise of doxycycline post-exposure prophylaxis (doxy-PEP) for STI prevention, awareness, uptake, and persistence remain limited.

In this qualitative, we study explored client perspectives on barriers and facilitators influencing the use of same-day PrEP and doxy-PEP to inform strategies for broader implementation in primary care. Informed by the stages of the PrEP Care Continuum and the levels of the SGM Health Disparities Framework, we sought to better understand the barriers and facilitators at each stage of the clinical continuum (i.e., awareness, uptake, and persistence) and at various levels of influence (i.e., individual, interpersonal, community, and societal).

Four virtual focus groups with 26 SGM clients with experience using PrEP and/or doxy-PEP were conducted. Data were analyzed using deductive thematic analysis guided by the PrEP Care Continuum and the SGM Framework.

Consistent barriers to uptake and persistence exist, including health care access, cost, stigma, and discriminatory clinical encounters. Participants highlighted the burden of the current medical model, which involves multiple procedural steps and frequent health care visits. Facilitators included community support, targeted social media messaging, and affirming providers. Notably, participants drew motivation from historical and communal narratives, including the legacy of the HIV/AIDS epidemic, and emphasized the need for visible public and political support for biomedical prevention.

The results underscore the importance of integrating client-informed approaches to improve biomedical prevention delivery. To advance HIV and STI prevention among SGMs, there is a critical need for culturally tailored education to support increasing awareness and flexible clinical models to support the uptake and persistence in care. PrEP and doxy-PEP are vital, synergistic tools that require coordinated strategies in primary care, to expand access and address persistent health disparities and end the HIV and STI epidemics.