Background
Doxycycline postexposure prophylaxis (DoxyPEP) patterns of counseling and uptake among European PrEP users are scarce. In Italy, no official DoxyPEP guidelines are available. Aims are to assess the prevalence of DoxyPEP counseling and use in Italy and to identify associated factors to guide equitable scale-up.
Methods
This is a cross-sectional analysis of PrEP users enrolled in the Italian PrIDE cohort (NCT07186244). PrIDE is an observational cohort enrolling individuals using PrEP throughout Italy. This analysis evaluates individuals enrolled from July 2024 to August 2025 in 14 hospital- and 3 community-based sited. Demographics and behavioral data (i.e. HIRI-MSM risk score, based on age, number of sexual partners, type of intercourse, chemsex, and previous STIs), geographic location and PrEP history at cohort enrolment (baseline) were collected. Groups were compared with nonparametric tests, as appropriate. Multivariable logistic regressions were applied and adjusted odds ratios (aORs) are presented.
Results
A total of 2,437 PrEP users were included; 2,402 (98.6%) were male at birth (2,381, 97.7% GBMSM), 58 (2.4%) transgender and 1,762 (72.3%) were already using PrEP at baseline (Table). Overall, 1359/2437 (55.7%) received DoxyPEP counseling; the likelihood of counseling increased over time (aOR 10.19 in 2024-Q4, 4.72 in 2025-Q1, 7.9 in 2025-Q2, 24.56 in 2025-Q3, versus 2024-Q3; all p<0.001). Counseling was more frequent in the Centre/South than in the North (aOR 1.89, 95%CI 1.5–2.4; p<0.001) and among people with HIRI-MSM ≥10 (aOR 1.62, 1.24–2.11; p<0.001). Females had lower odds (0.25, 0.06–0.92; p=0.042). Overall, 435/2437 (17.8%) reported DoxyPEP use. Use was more frequent in community-based than hospital settings (aOR 2.0, 1.28–3.12; p=0.002), in the North vs Centre/South (aOR 0.64, 0.43–0.93; p=0.023), among people with HIRI-MSM ≥10 (aOR 2.85, 1.76–4.89; p<0.001), sex workers (aOR 2.59, 1.25–5.35; p=0.01), and with ongoing PrEP at baseline (aOR 8.91, 4.99–17.65; p<0.001). Lower odds of use were observed among transgender/non-binary individuals (aOR 0.11 0.02–0.42; p=0.006).
Conclusions
In this nationwide PrEP cohort, DoxyPEP counseling expanded rapidly and was directed toward people at increased STI risk; actual use involved about one in six PrEP users, with alignment to behavioral risk. DoxyPEP implementation should standardize counseling and strengthen inclusive delivery while maintaining risk-proportionate use.
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