(P115) "I DON'T SEE MYSELF AS A GATEKEEPER": DOXY-PEP KNOWLEDGE, ATTITUDES AND PRACTICES AMONG HEALTHCARE PROVIDERS IN NEW YORK

Background:
Doxycycline post-exposure prophylaxis (Doxy-PEP) can prevent STIs. Despite its efficacy, CDC guidance remains preliminary and incorporation into provider practice has been limited. Few studies have assessed provider knowledge, attitudes, and practices (KAP) regarding Doxy-PEP. We studied KAP among healthcare providers in New York State, which ranks 14th, 15th, and 22nd for chlamydia, gonorrhea, and syphilis incidence in the US, respectively.

Methods:
Between July 2023-January 2024, 18 in-depth, semi-structured interviews were conducted with healthcare providers including infectious disease physicians (n=8), adolescent medicine physicians (n=2), an emergency medicine physician (n=1), nurse practitioners (n=4), and physician assistants (n=3). We analyzed transcripts according to KAP constructs, which were iteratively refined to identify the following five themes: STI Incidence/Disparities (Knowledge), Doxy-PEP Experience (Knowledge), Doxy-PEP Benefits (Attitudes), Doxy-PEP Concerns (Attitudes), and Doxy-PEP Implementation Challenges (Practice Implications).

Results:
Providers recognized the national rise in STIs and attributed this to impacts of COVID-19 and disparities in both sexual health education and access to prevention services. Doxy-PEP knowledge was high: all providers were aware of Doxy-PEP; most (78%) prescribed it to patients. Knowledge gaps included counseling approaches for patients with daily exposures. Doxy-PEP benefits included its potential to reduce stigma and anxiety among patients. Doxy-PEP concerns included its potential contribution to antimicrobial resistance. Implementation challenges included competing priorities and difficulties obtaining prior authorization for prescriptions.

Conclusion:
This sample of New York providers were aware that STI incidence is increasing nationwide and reflects larger disparities in access to healthcare and health information. Further, they welcomed the addition of Doxy-PEP among available STI prevention strategies. Concerns about antimicrobial resistance were common. Accordingly, providers indicated the need for Doxy-PEP to be targeted to patients with a history of recurrent STIs who remain vulnerable to reinfection. However, they also expressed discomfort with being “gatekeepers”, by withholding or restricting access to Doxy-PEP especially when requested by patients.