High Willingness to Use and Recommend Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention in Peru.

BACKGROUND

Bacterial sexually transmitted infections (STIs) remain prevalent among men who have sex with men (MSM) and transgender women (TGW) in Peru. Doxycycline postexposure prophylaxis (doxy-PEP) is a promising prevention strategy, but data from Latin America remain limited.

METHODS

We conducted 2 online surveys in Lima, Peru (September-October 2024). One assessed willingness to use doxy-PEP among MSM and TGW; the other assessed willingness to recommend doxy-PEP among health care providers (HCPs). Logistic regression evaluated correlates of high willingness.

RESULTS

Of 730 eligible MSM and TGW, 447 completed outcome measures. Overall, 82.1% expressed willingness to use doxy-PEP, 34.2% expressed high willingness. High willingness was associated with ≥5 anal sex partners in the past 3 months (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.06-3.24), prior HIV preexposure prophylaxis use (aOR, 2.56; 95% CI, 1.40-4.71), living with HIV (aOR, 2.74; 95% CI, 1.44-5.24), and concern about needing a prescription (aOR, 3.33; 95% CI, 1.99-5.66). Concerns about side effects (aOR, 0.55; 95% CI, 0.31-0.98) and microbiome disruption (aOR, 0.51; 95% CI, 0.29-0.87) were negatively associated. Most participants preferred doxy-PEP over daily doxycycline (64.0% vs. 28.6%). Among 132 HCPs, 54.5% were involved in HIV/STI care; 87.1% expressed willingness to recommend doxy-PEP, and 89.4% would do so if included in national guidelines. Limited diagnostic capacity and risk of unofficial use were most frequently endorsed concerns.

CONCLUSIONS

High willingness to use or recommend doxy-PEP was observed among clients and HCPs in Peru, providing evidence to guide integration into sexual health services in Latin America.