Background
Groundbreaking innovations in prevention of syphilis, chlamydia, and gonorrhea (STIs) with doxycycline postexposure prophylaxis (doxy-PEP) and HIV with long-acting cabotegravir (CAB-LA) have the potential to reduce population-level incidence of STIs and HIV. For maximal effectiveness, these tools must reach those with high STI and HIV rates. In San Francisco (SF) in 2024, STI rates among cisgender men (CGM) were highest in Black CGM; new HIV diagnosis rates were highest in Black and Latino/a persons. From 2023-2024, new HIV diagnoses among cisgender women (CGW) nearly doubled (from 14 to 26). The SF GTZ Consortium is monitoring rollout of doxy-PEP and CAB-LA prescribing in 3 large capacity SF clinics.
Methods
Two sexual health clinics and one HIV clinic provided quarterly data on the number of clients given new doxy-PEP and CAB-LA prescriptions (rx) from October 2022 through June 2025. New rx were tracked by gender, race/ethnicity, and age. Clinics also provided demographics for CGM and transgender women (TGW) who had not previously been prescribed doxy-PEP and for clients without HIV who had not previously been prescribed CAB-LA. We compared the proportion of potentially eligible clients in different groups provided new rx using logistic regression.
Results
Doxy-PEP was newly prescribed to 6,797 (19%) of CGM/TGW. Doxy-PEP was more likely to be prescribed to CGM than TGW, to Latino/a and Asian/Pacific Islander than White clients, and to clients <50 years (Table). Black clients were less likely to receive a doxy-PEP rx. CAB-LA was newly prescribed to 206 (0.8%) clients without HIV in the 3 clinics. CAB-LA was more likely to be prescribed to TGW and other genders than CGM, to Latino/a than White clients, and to clients aged 18-29 and 40-49 years than 50+ years. CGW were less likely to receive a CAB-LA rx than CGM.
Conclusions
Doxy-PEP rollout in SF was substantial, although Black and TGW clients were less likely to receive a rx, despite high STI rates. CAB-LA rollout was modest (but many clients without HIV were already taking oral PrEP or not eligible for CAB-LA per clinic protocols). CAB-LA rx was higher among TGW and Latino/a clients, both with high rates of new HIV diagnoses in SF. The increase in HIV diagnoses among CGW in SF and high rates in Black CGM suggest these groups should be prioritized for PrEP, including injectables. These data will guide citywide efforts to increase doxy-PEP and CAB-LA awareness, prescribing, and access for populations most affected by STIs and HIV.
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