MEASURING DOXYPEP USE RELATIVE TO STI RATES AT A SAN FRANCISCO STI CLINIC REVEALS RACIAL INEQUITIES IN DISEASE...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Equity

Background:

• Doxycycline postexposure prophylaxis (doxyPEP) is crucial for reducing bacterial sexually transmitted infections (STIs) and addressing health inequities.
• Existing PrEP-to-Need Ratios (PNR) have identified disparities in HIV pre-exposure prophylaxis (PrEP) access.
• This study applies a novel PNR framework to doxyPEP to assess racial/ethnic inequities in STI prevention.

Purpose of the Study:

• To evaluate the doxyPEP-to-Need Ratio (dPNR) as a metric for identifying inequities in doxyPEP access.
• To compare doxyPEP use relative to the need for STI prevention across different racial and ethnic groups.

Main Methods:

• A cross-sectional analysis used clinical and surveillance data from San Francisco City Clinic.
• DoxyPEP use was compared against the number of STI diagnoses (chlamydia, gonorrhea, early syphilis) among eligible patients.
• The doxyPEP-to-Need Ratio (dPNR) was calculated and stratified by race/ethnicity and year.

Main Results:

• DoxyPEP use was highest among eligible Latine (76%), Asian (71%), and White (67%) patients, and lowest among Black patients (59%).
• Despite higher infection rates, Latine and Black patients had lower dPNRs compared to Asian and White patients.
• Persistently lower doxyPEP use relative to need was observed for Latine and Black patients compared to White patients.

Conclusions:

• The doxyPEP-to-Need Ratio (dPNR) is a novel and valuable tool for identifying actionable inequities in doxyPEP access.
• This metric can guide interventions to improve equitable access to STI prevention strategies.