Presentation:
Doxycycline post-exposure prophylaxis (doxy-PEP) is highly effective in reducing bacterial STIs among men who have sex with men (MSM) and transgender women (TGW). Optimizing the public health impact of this highly effective STI prevention tool while minimizing potential risks will require a multi-pronged, equity-centered implementation strategy. The US Centers for Disease Control and Prevention draft doxy-PEP guidelines give a grade 1A recommendation for doxy-PEP for MSM and TGW with a history of an STI in the past year. Other national, state and local health jurisdictions have released guidance with broader or more limited eligibility for the use of doxy-PEP. Key implementation considerations include: Who should be offered doxy-PEP and in what settings? What counseling should be provided to individuals receiving doxy-PEP? How can doxy-PEP uptake, adherence and persistence be maximized across age and racial/ethnic groups? What training and tools do providers need to integrate doxy-PEP into their practice? What is the risk of antimicrobial resistance in STI and non-STI pathogens with longer-term use of doxy-PEP, and how should this be monitored? How can the effect of doxy-PEP on STI incidence be monitored and how success can be measured? What are the findings to date in terms of the uptake and impact of doxy-PEP in early adopter cities? In this symposium, we will review these key questions, highlight areas of controversy across existing doxy-PEP guidelines, and discuss the available evidence on doxy-PEP implementation outside of the clinical trial setting.