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<p>The San Francisco health department released guidelines on doxycycline post-exposure prophylaxis (doxy-PEP) for sexually transmitted infection (STI) prevention in October 2022. Guidelines recommended doxy-PEP for transgender women (hereafter trans women) and men who have sex with men with a history of bacterial STI and condomless anal or oral sex in the last year. We assessed doxy-PEP awareness and use among trans women in San Francisco using National HIV Behavioral Surveillance (NHBS) data from July 2023–May 2024, spanning 9–19 months after guideline release. In-person interviews recorded demographics, behaviors, HIV serostatus, STI history, and doxy-PEP awareness, discussion with a provider, and use in the last year. Among 339 trans women surveyed, 37% were aware of doxy-PEP. In the last year, 20% discussed doxy-PEP with a provider and 11% used doxy-PEP. Among trans women not living with HIV, awareness was correlated with age under 50 years (AOR 3.86, CI 1.92–7.74), engaging in sex work (AOR 1.85, 95% CI 1.02–3.38), and testing positive for a bacterial STI (AOR 2.92, 95% CI 1.35–6.33). Among those living with HIV, awareness of doxy-PEP was correlated with testing positive for an STI (OR 3.05, 95% CI 1.22–7.64). Despite efficacy demonstrated for trans women in clinical trials and health department guidelines prioritizing doxy-PEP for trans women, awareness of this effective STI prevention method was low. These findings mirror the experience with HIV PrEP roll-out for trans women. Targeted interventions and differentiated delivery models are needed to improve access, engagement, and uptake in this population.</p>

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Doxycycline Post-exposure Prophylaxis Awareness and Use Among Transgender Women in San Francisco, 2023–2024: Assessment One Year After Release of Health Department Guidance

  • 期刊论文

  • 发表日期：

    2025年10月11日

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  • Rachel Brandão Raskin,
  • Iris R. O’Neal,
  • Gabriel Tariq Xavier Salomão de Pina,
  • Erikka Palafox,
  • Bow Suprasert,
  • Raul Ruiz,
  • Moranda Tate,
  • Glenda N. Baguso,
  • Stephanie E. Cohen,
  • Willi McFarland,
  • Erin C. Wilson

摘要

The San Francisco health department released guidelines on doxycycline post-exposure prophylaxis (doxy-PEP) for sexually transmitted infection (STI) prevention in October 2022. Guidelines recommended doxy-PEP for transgender women (hereafter trans women) and men who have sex with men with a history of bacterial STI and condomless anal or oral sex in the last year. We assessed doxy-PEP awareness and use among trans women in San Francisco using National HIV Behavioral Surveillance (NHBS) data from July 2023–May 2024, spanning 9–19 months after guideline release. In-person interviews recorded demographics, behaviors, HIV serostatus, STI history, and doxy-PEP awareness, discussion with a provider, and use in the last year. Among 339 trans women surveyed, 37% were aware of doxy-PEP. In the last year, 20% discussed doxy-PEP with a provider and 11% used doxy-PEP. Among trans women not living with HIV, awareness was correlated with age under 50 years (AOR 3.86, CI 1.92–7.74), engaging in sex work (AOR 1.85, 95% CI 1.02–3.38), and testing positive for a bacterial STI (AOR 2.92, 95% CI 1.35–6.33). Among those living with HIV, awareness of doxy-PEP was correlated with testing positive for an STI (OR 3.05, 95% CI 1.22–7.64). Despite efficacy demonstrated for trans women in clinical trials and health department guidelines prioritizing doxy-PEP for trans women, awareness of this effective STI prevention method was low. These findings mirror the experience with HIV PrEP roll-out for trans women. Targeted interventions and differentiated delivery models are needed to improve access, engagement, and uptake in this population.