Background
The CDC recently issued guidelines recommending doxycycline post-exposure prophylaxis (doxyPEP) for men who have sex with men (MSM) who have had a bacterial sexually transmitted infection (bSTI) in the past year. However, this strategy remains underutilized among some groups. The primary objective of this study was to explore doxyPEP use, prescription within participants’ primary HIV clinics, and the association of doxyPEP use with HIV care continuum outcomes among MSM with HIV in the U.S.
Methods
From 11/2023-8/2024, we recruited 936 cisgender MSM with HIV from 46 U.S. states, Washington D.C., and Puerto Rico via Grindr (Fig. 1). Viral suppression (VS) was confirmed via HIV viral load testing and ART adherence was objectively assessed by point-of-care urine tenofovir rapid assay (UTRA). Associations between ART adherence, HIV VS, and engagement in HIV care and the independent variable of doxyPEP awareness and use were explored by logistic regression adjusted for age and race/ethnicity.
Results
Overall, 56% of participants were aware of doxyPEP and 12% were prescribed it. Awareness of doxyPEP was associated with increased HIV care engagement (OR=1.7, 95% CI=1.2-2.7) and VS (OR=2.27, 95% CI=1.30-3.70). There were no significant differences in ART adherence rates by UTRA, VS, or attending an appointment with their HIV care provider in the last six months by doxyPEP use. There was more doxyPEP use among those reporting a bSTI in the past year (aOR=2.6, 95% CI=1.63-4.14) and lower uptake of doxyPEP in the Midwest (aOR=0.81, 95% CI=0.69-0.95) and South (aOR=0.86, 95% CI=0.75-0.98) vs. the Northeast and Pacific regions. No sociodemographic characteristics were associated with doxyPEP awareness. Of 353 respondents eligible for doxyPEP per CDC guidelines, only 20% were currently prescribed doxyPEP and 31% remained unaware of doxyPEP. Of the 413 respondents unaware of doxyPEP, 83% were interested in doxyPEP and 80% of those not on doxyPEP stated they would start if offered at their HIV care clinic.
Conclusions
DoxyPEP awareness was associated with VS and HIV care engagement in the U.S. and high interest in doxyPEP highlights the potential importance of comprehensive integrated HIV/sexual health care. Although knowledge of doxyPEP was similar among MSM across the U.S., there were regional disparities in uptake. Continued research on doxyPEP and HIV outcomes is necessary to ensure doxyPEP implementation and rollout among MSM with HIV appropriately targets groups most impacted by the STI epidemic.
Table or Figure
