Patient Information, Motivations, and Behavioral Skills during Early Implementation of Doxy-PEP in New York City

BACKGROUND: Doxycycline post-exposure prophylaxis (doxy-PEP) has been shown to be an effective strategy for preventing bacterial sexually transmitted infections (STIs); however, factors affecting its uptake, persistence, and effective use have yet to be thoroughly explored. This study qualitatively assessed the information, motivations, and behavioral skills (IMB) related to doxy-PEP uptake and use among a health-seeking sample in New York City. METHODS: Between July 2023 and January 2024, in-depth semi-structured interviews were conducted with fourteen patients attending an academic sexual heath clinic in Northern Manhattan. Transcripts were analyzed using an IMB framework-guided thematic analysis with additional deductive codes to identify subthemes. RESULTS: Half of the patients interviewed were using doxy-PEP at the time of interview (n=7). Major IMB themes included Information: doxy-PEP Knowledge/Awareness, and Information: doxy-PEP Information Sources; Motivations: STI Vulnerability, Motivations: Concerns about Side-Effects, and Motivations: Concerns about Antimicrobial Resistance; and Behavioral Skills: doxy-PEP access, and Behavioral Skills: Timing of Sexual Activity. CONCLUSIONS: This qualitative analysis identified several IMB factors that may help guide ongoing efforts to increase equitable access and effective use of doxy-PEP. Patients were generally well-informed about doxy-PEP, though some confusion regarding the strategy was noted, which supports ongoing patient education. Specific concerns related to antimicrobial resistance emerged as factors that may affect both intention and motivation to adopt and continue using doxy-PEP, emphasizing the importance or resistance monitoring. Finally, complementary behavioral strategies that were described, such as the "clumping" sexual partners, requires additional study to discern how this may affect long-term doxy-PEP effective use.