Community-engaged implementation strategies to increase doxycycline post-exposure prophylaxis uptake among men who have sex with men in China (DoxyForward): a three-group, open-label, randomised controlled trial.
Thomas S Fitzpatrick, Peizhen Zhao, Peng Liang et al.
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In 30 seconds
DoxyForward was a three-group, open-label randomised controlled trial at community-based organisations in seven Chinese provinces, testing community-engaged strategies to increase doxycycline post-exposure prophylaxis (doxy-PEP) use among men who have sex with men. Among 399 enrolled index participants, use after condomless sex at six months was reported by 41% with co-created educational materials alone, 76% with materials plus pay-it-forward access to free doxy-PEP, and 73% when peer distribution was added. Both layered strategies increased uptake compared with co-creation alone; peer distribution also outperformed referral to community organisations among recruited peers.
Key findings
- At six months, doxy-PEP use was 48 (41%) of 117 with co-creation alone, versus 89 (76%) of 117 with co-creation plus pay-it-forward (RD 31·3 [95% CI 19·1-43·6]; p<0·0001).
- Use was 80 (73%) of 109 with co-creation, pay-it-forward, and social network distribution (RD 34·3 vs co-creation [22·5-46·2]; p<0·0001).
- Among alter participants, use was 32 (68%) of 47 receiving doxy-PEP through social network distribution versus 39 (40%) of 98 referred to community-based organisations (RD 28·3 [95% CI 11·8-44·8]; p<0·0001).
- Before the study, 27 (7%) of index participants had used doxy-PEP.
Why it matters
The trial suggests that access and delivery approaches developed with community members can substantially increase doxy-PEP uptake where prior use is low. The peer-distribution result also indicates that extending access through social networks may reach people who might not obtain doxy-PEP through referral to community-based organisations. These findings inform implementation planning, alongside the need to consider the study setting and population.
What to keep in mind
The trial was conducted among community-based organisation attendees in China, and all enrolled index participants were cisgender men; applicability to other populations and settings is uncertain.