Doxycycline Postexposure Prophylaxis in the Dominican Republic: Investigating Healthcare Provider Knowledge, Attitudes, and Practices in a Caribbean Clinical Setting.

BACKGROUND

Doxycycline postexposure prophylaxis (Doxy-PEP) is effective in preventing bacterial sexually transmitted infections (STIs), yet little is known about contextual factors and barriers influencing its implementation outside of the United States and Europe. In Latin America and the Caribbean, provider knowledge, attitudes, and practices (KAP) regarding Doxy-PEP remain largely unexplored. This study assessed physician perspectives on this prevention tool at a clinic in the Dominican Republic.

METHODS

Between June and August 2024, semi-structured interviews were conducted in Spanish with 12 physicians at Clínica de Familia La Romana. Transcripts were translated and analyzed using inductive KAP codes, with deductive coding applied to identify subthemes.

RESULTS

Major themes included: (1) STI disparities, (2) STI management experiences, (3) Doxy-PEP benefits, (4) Doxy-PEP concerns, (5) Doxy-PEP implementation, and (6) patient selection. Familiarity with Doxy-PEP was limited, with only one provider reporting prior use. Providers attributed rising STI rates to gaps in community knowledge and socioeconomic disparities and mentioned the added local challenges of self-medication and unregulated antibiotic use. Perceived benefits of Doxy-PEP included its preventive potential, affordability, and dosing simplicity. Concerns included potential misuse contributing to antimicrobial resistance, particularly given over-the-counter antibiotic availability. Providers emphasized the need for standardized patient counseling and prescribing guidelines to ensure appropriate and equitable use.

CONCLUSIONS

Providers view Doxy-PEP as a promising prevention tool, but successful implementation will require uniform guidance and education reflecting the local healthcare context. Provider perspectives are essential to guide responsible rollout in the Dominican Republic and other low- and middle-income settings across the region.