Awareness and willingness toward doxycycline post-exposure prophylaxis use for bacterial sexually transmitted infections among men who have sex with men

Background Doxycycline post-exposure prophylaxis (doxy-PEP) has shown efficacy in preventing bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM). We aimed to investigate the awareness and willingness toward doxy-PEP among MSM in the real-world setting. Methods From October 2023 to March 2024, we enrolled MSM aged ≥18years, including people with HIV and PrEP users in Taiwan. Participants completed a questionnaire interview on sexual behaviors, STI history, and awareness and willingness to use doxy-PEP. Factors associated with willingness and doxy-PEP prescription were identified. Results Of 1100 participants (median age, 36years), 75.5% were people with HIV and 24.5% were PrEP users. Among them, 29.8% (328/1100) had heard of doxy-PEP. After education and counseling, 85.9% (945/1100) expressed willingness to use doxy-PEP and 45.6% (431/945) received prescriptions for doxy-PEP. In multivariable analysis, willingness to use doxy-PEP was associated with engaging in anal sex (AOR2.98, 95% CI1.01-8.78), having fixed sexual partners (AOR0.53, 95% CI0.34-0.82), using recreational drugs (AOR1.59, 95% CI1.01-2.50) and receiving suggestions from healthcare providers (AOR1.89, 95% CI1.22-2.91). Starting doxy-PEP was associated with having a bachelor's degree or higher (AOR1.47, 95% CI1.03-2.09), more than five sexual partners (AOR1.97, 95% CI1.18-3.27), chlamydia history (AOR1.92, 95% CI1.23-2.99), suggestions from healthcare providers (AOR 1.64, 95% CI1.10-2.45) and information from scientific research papers (AOR1.34, 95% CI1.01-1.79). Conclusions MSM in Taiwan had high willingness toward doxy-PEP, which was correlated with their at-risk sexual behavior. Understanding factors influencing willingness and counseling from healthcare providers may guide doxy-PEP implementation.