A Qualitative Study of Doxycycline Post-Exposure Prophylaxis Knowledge, Attitudes and Practices Among Healthcare Providers in New York City

Abstract

Abstract Background Three randomized controlled trials have demonstrated the efficacy of doxycycline for bacterial sexually transmitted infection post-exposure prophylaxis (Doxy PEP). Few studies have assessed provider knowledge, attitudes, and practices (KAP) regarding Doxy PEP implementation. Between July of 2023 and January 2024, this study qualitatively assessed KAP and intention to prescribe Doxy PEP among healthcare providers in the New York City area. Methods In-depth, semi-structured individual interviews were conducted with 18 healthcare provider key informants including physicians, nurse practitioners and physician assistants from various practice settings. Transcripts were analyzed using inductive KAP codes, with additional deductive coding used to identify emergent subthemes. Results The following themes were identified: (1) STI Disparities, (2) Doxy PEP Experience, (3) Doxy PEP Benefits, (4) Doxy PEP Concerns, and (5) Doxy PEP Implementation. Doxy PEP knowledge was high, with all providers being aware and most (78%) having prescribed it to at least one patient at the time of interview. Providers were knowledgeable of factors contributing to high rates of STIs. Benefits included reducing STI anxiety. Concerns included contributing to antimicrobial resistance and impacts on microbiota. Practice implications included challenges getting Doxy PEP approved by the pharmacy. These factors were shown to affect Doxy PEP’s perceived acceptability. Conclusions To ensure that Doxy PEP is implemented safely and equitably, KAP factors that may influence provider decision-making should be examined. Understanding providers’ knowledge, attitudes, and practices and how they affect intention to prescribe Doxy PEP, and to what patients, has important implications for successful implementation.