Background
Louisiana ranks first in the nation for chlamydia incidence and third for gonorrhea, necessitating effective prevention strategies for sexually transmitted infections (STIs). Doxycycline post-exposure prophylaxis (doxy PEP) has emerged as a promising prevention strategy, but its success relies on acceptability among healthcare providers and clients. In particular, it is important to understand acceptability of doxy PEP among persons assigned female at birth (AFAB), who stand to gain substantial benefit but for whom doxy PEP has not yet demonstrated clinical efficacy.
Methods
A survey was administered to healthcare providers across various specialties and clients AFAB in Southeastern Louisiana. Clients had multiple partners or an STI diagnosed in the past 2 years. The provider survey assessed familiarity with doxy PEP guidelines, prescribing habits, and desire for education. The client survey assessed sexual behaviors and awareness and acceptability of doxy PEP.
Results
There were 156 respondents (136 providers, 20 clients). Demographic information is in Table 1. Among providers, 25.0% (34/146) were trained in Infectious Diseases (ID). More than half (52.2%, 71/136) were familiar with doxy PEP guidelines. Only 25.0% (34/136) had prescribed doxy PEP, and 67.6% (23/34) had prescribed it <5 times in the past 6 months. ID providers were more likely to have prescribed doxy PEP than other providers (41.2% vs 19.6%, p=0.01). Six (4.4%) providers had prescribed doxy PEP to individuals AFAB. Of those who had not prescribed doxy PEP, 81.4% (83/102) believed there was enough evidence to prescribe it going forward and 72.8% reported they would like training. Among clients AFAB, 9 (45.0%) identified as LGBTQ+, 3 (15.0%) reported >/=5 partners in the past 6 months, 9 (45.0%) reported having sex more than once per week, and 7 (35.0%) had prior knowledge of doxy PEP. Responses on likelihood of using doxycycline to prevent STIs (“if available and suggested by your provider”) were 50.0% (10/20) “very likely,” 35.0% (7/20) “likely,” and only 15.0% (3/20) “unlikely.”
Conclusions
Doxy PEP prescribing is not widespread in Southeastern Louisiana, although there is willingness to prescribe among providers; educational initiatives are needed. Additionally, clients AFAB have some awareness and strong acceptability of doxy PEP. Although our client sample is small, these are the first data to our knowledge on doxy PEP acceptability in persons AFAB in the US and are encouraging for feasibility of future trials.