Attitudes, knowledge, facilitators, and barriers to doxycycline post-exposure prophylaxis for sexually transmitted infections among gay and bisexual men who have sex with men and trans-gender women: A mixed-methods scoping review.

Abstract

BackgroundAs doxycycline post-exposure prophylaxis (doxyPEP) implementation for bacterial STI prevention expands among gay, bisexual and other men who have sex with men (GBMSM) and transgender women (TGW), this scoping review synthesised community knowledge, attitudes, barriers, facilitators and practices to inform guidelines and support uptake.MethodsThis scoping review followed JBI methodology and was reported per PRISMA-ScR. Three databases (Embase, Medline/PubMed, Web of Science) were searched for articles on community perspectives of doxyPEP among GBMSM and TGW published from 2013 to 2025. Included studies were screened, data extracted using inductive coding, and analysed thematically. Factors were mapped onto the Knowledge, Attitudes, and Practices (KAP) Model.Results24 studies (18,428 participants) met inclusion criteria, (North America (n = 12), Europe (n = 6), Asia (n = 3), Oceania (n = 3)). Most were quantitative (n = 20), with two qualitative and two mixed-methods studies, recruiting primarily via online/app-based surveys or from sexual health clinics. Five coding categories emerged: awareness and knowledge; previous use; willingness to try; barriers and concerns; and facilitators and predictors. Awareness and prior use were low and heterogenous (ranging from 17 to 67%), yet willingness was moderate to high (12% to 90%), particularly after brief education and when free of charge. Prior use remained limited (2.5-36%). Predictors of interest included prior STI diagnosis, HIV PrEP use, living with HIV, multiple sexual partners, condomless sex, and higher educational attainment. Side effects and antimicrobial resistance (AMR) were the primary concerns.ConclusionsClinicians and sexual health services should prioritise opportunistic doxyPEP offers to those with recent STIs, HIV PrEP use, or HIV, embedding education and low/no-cost access within routine care to close the awareness-uptake gap. Public health bodies should invest in robust AMR surveillance alongside implementation, and community-based education should directly address side-effect concerns. Extending research and delivery models to under-represented groups is also needed to ensure equitable, evidence-based uptake.