Background:
The use of 200 mg of doxycycline within 72 hours after condomless sex (‘doxyPEP’) has been shown to decrease the incidence of bacterial sexually transmitted infections (bSTI) in 2 randomized trials that enrolled cisgender men who have sex with men (MSM) and transgender women. However, limited data are available to inform the implementation of this novel STI prevention intervention in primary care settings. This report describes the doxyPEP roll-out in a Boston health center that specializes in primary care for sexual and gender minorities.
Methods:
Data from the clinic’s electronic medical records were abstracted. Among all patients screened for a bSTI in 2023, bivariate logistic regression was used to compare characteristics of those receiving doxyPEP and those not receiving doxyPEP. DoxyPEP uptake (proportion receiving doxyPEP in 2023) among those with an active PrEP prescription in 2022-2023, PLHIV, and those tested for, and those diagnosed with, a bSTI in 2022 were also calculated.
Results:
Between January 26 and September 6, 2023, 1120 patients received a doxyPEP prescription. By March, monthly doxyPEP starts exceeded 100, with >250 patients initiating doxyPEP in June, 2023. Most doxyPEP patients were White (73.3%), non-Latinx (81.7%), and cisgender MSM (92.2%), with a mean age of 39.1 years. Among all patients screened for a bSTI in 2023 (N=4976), those receiving doxyPEP were more likely to be PrEP users (73.8% vs. 39.9%, odds ratio [OR]=4.25, 95%CI=3.67-4.93), have private insurance (85.4% vs. 71.3%, OR=2.37 [1.96-2.81]), have been diagnosed with a bSTI in 2022 (31.3% vs. 15.0%, OR=1.67 [1.42-1.98]), and less likely to be people living with HIV (PLHIV; 8.6% vs. 18.1%, OR=0.42 [0.34-0.53]) than those who did not receive doxyPEP. DoxyPEP users did not differ from non-users by age, race or ethnicity. DoxyPEP uptake was 24.1% (827/3427) among patients with an active PrEP prescription, 4.8% (96/2012) among PLHIV, 13.7% (900/6568) among those screened for a bSTI in 2022 and 24.7% (350/1416) among those diagnosed with a bSTI in 2022.
Conclusions:
Over 1,000 patients initiated doxyPEP in less than 6 months at a Boston health center. PrEP users were more likely to initiate doxyPEP than PLHIV, but most patients recently diagnosed with a bSTI had not received doxyPEP. The increased uptake among patients with private insurance compared to those with public insurance highlights the need for programs to facilitate doxyPEP access in an equitable manner.