Acceptability and use of doxyPEP among cisgender men who have sex with men, transgender women and non-binary persons assigned male sex at birth: results from a national online survey from the USA

BACKGROUND: Sexually transmitted infections (STIs) have continued to rise in the USA, and doxycycline postexposure prophylaxis (doxyPEP) has shown prevention efficacy for bacterial STIs. We sought to evaluate doxyPEP interest, use and its associated factors among a national sample of eligible users. METHODS: Using national advertisements on a social networking application for men who have sex with men (MSM), we recruited participants to complete an anonymous cross-sectional online survey from 1 March to 30 April 2023. Analyses of doxyPEP user characteristics and factors associated with use were restricted to respondents assigned male sex at birth, residing in the USA and eligible for doxyPEP. Eligibility was defined as self-report of a bacterial STI in the past year following the US Centers for Disease Control and Prevention guidelines. A multivariate logistic regression model was used to evaluate the factors associated with doxyPEP use. RESULTS: Of 1428 respondents, only 9% reported ever using doxyPEP and 2.5% reported current use. Most respondents (88.3%) not currently on doxyPEP were interested in using it. Among the 471 eligible respondents included in the analysis, the median age was 37 years; the majority (93.6%) identified as cisgender MSM, 2.5% as transgender and 3.8% as non-binary. Most respondents were from the Southern United States (29.5%) and Western United States (37.6%). Among the eligible participants, 17.0% ever used doxyPEP. The majority received doxyPEP from their healthcare provider or STI clinic. Self-identifying as black race (adjusted OR (aOR) 3.08, 95% CI 1.31 to 7.16), reporting a higher number of sex partners (aOR 1.02, 95% CI 1.01 to 1.03), current pre-exposure prophylaxis use (aOR 3.61, 95% CI 1.55 to 9.74) and living with HIV (aOR 3.08, 95% CI 1.20 to 8.83) were associated with doxyPEP use in a multivariable model. CONCLUSION: A national online survey among cisgender MSM, transgender and non-binary persons showed high interest but low use of doxyPEP, which was expected as there were no national guidelines in place at the time. These findings provide baseline estimates to inform future monitoring of doxyPEP uptake.