Post by The Lancet Infectious Diseases

🆕 Community-engaged implementation strategies significantly increase doxycycline post-exposure prophylaxis (doxy-PEP) uptake in a setting with low baseline use. Co-creation and pay-it-forward work synergistically to increase doxy-PEP use. 💊 Thomas S Fitzpatrick, Peizhen Zhao and colleagues conducted a three-group, open-label, randomised controlled trial in seven provinces in China. Men who have sex with men (MSM; n=399) receiving sexual health services at community based organisations were randomly allocated (1:1:1) to: co-creation alone (co-creation group), which provided educational materials introducing doxy-PEP co-created with local MSM community members; co-creation plus pay-it-forward (CC + PIF group), which additionally offered free doxy-PEP supported by peer donations with an optional invitation to donate; or co-creation plus pay-it-forward with social network distribution (CC + PIF + SND group), which provided additional doxy-PEP to distribute to peers. Randomly allocated participants (index participants) from the co-creation and CC + PIF + SND groups recruited MSM peers (alter participants). Primary outcome was doxyPEP use within 72 h of condomless anal or oral sex with a male partner on one or more occasions at 6 months. Proportions of alter participants who achieved the primary outcome were compared between the co-creation and CC + PIF + SND groups. 📊 Doxy-PEP use after condomless sex at six months was reported by 48 (41%) of 117 of index participants in the co-creation group, 89 (76%) of 117 in the CC + PIF group (risk difference [RD] 31·3 vs co-creation group [95% CI 19·1–43·6]; p<0·0001), and 80 (73%) of 109 in the CC + PIF + SND group (RD 34·3 vs co-creation group [22·5–46·2]; p<0·0001). Doxy-PEP use was also higher among alter participants who received doxy-PEP through social network distribution than referral to community-based organisations (32 [68%] of 47 vs 39 [40%] of 98; RD 28·3 [95% CI 11·8–44·8]; p<0·0001). 💡 Timely evidence to inform doxy-PEP guidelines in LMICs as well as equitable and impactful global rollout of doxy-PEP. Read the full paper here: https://bit.ly/4vJwtNM #doxypep, #China, #payitforward, #menwhohavesexwithmen Peng Liang, Chuning Liu, Zeyu Wen, Runxian Lin, Qian Zou, Jason J Ong, Shujie Huang, Weiming Tang, Joseph D. Tucker, Cheng Wang