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The dPEP Kenya Study, the first trial of doxyPEP for STI prevention among cisgender women, found that doxyPEP did not reduce STIs in the setting of low use of doxyPEP by objective drug concentrations. To assess barriers and facilitators to doxyPEP adherence, we explored participants' experiences during the dPEP Kenya Study. We conducted serial in-depth interviews (n\u2009=\u200940) and 4 focus group discussions (n\u2009=\u200929) of participants randomized to take doxyPEP. Transcripts were analyzed using an inductive content analysis approach. Side effects, such as nausea from taking doxyPEP on an empty stomach, dosage interpretation challenges, pill burden, and concerns about stigma and partner reactions hindered adherence. Support from partners, family, and peers, familiarity with doxycycline, and the use of discreet pill carriers facilitated doxyPEP use. Decreasing dosage frequency, promoting the use of discreet pill carriers, and addressing stigma through community-driven communication strategies may improve future doxyPEP uptake and adherence. Clinical trial number. This trial was registered in the ClinicalTrials.gov under registration number, NCT04050540 on 06th August 2019.<\/jats:p>","DOI":"10.1186\/s12879-025-11209-6","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:05:52Z","timestamp":1751371552000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding barriers and facilitators to doxycycline post-exposure prophylaxis adherence among young women in western kenya: a qualitative study"],"prefix":"10.1186","volume":"25","author":[{"given":"Benn","family":"Kwach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Kwena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren 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STI and HIV incidence among women in PrEP trials. Sexually Transmitted Infections. 2019;95(2):125\u20139.","journal-title":"Sexually Transmitted Infections"},{"issue":"5","key":"11209_CR3","doi-asserted-by":"crossref","first-page":"e620","DOI":"10.1016\/S2214-109X(21)00025-5","volume":"9","author":"C Dat","year":"2021","unstructured":"Dat C. STI prevalence and impact on reproductive health in young women. Lancet Glob Health. 2021;9(5):e620\u20139.","journal-title":"Lancet Glob Health"},{"issue":"2","key":"11209_CR4","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1056\/NEJM200107123450201","volume":"345","author":"RB Nadelman","year":"2001","unstructured":"Nadelman RB, Nowakowski J, Fish D, Falco RC, Freeman K, McKenna D, Welch P, Marcus R, Ag\u00fcero-Rosenfeld ME, Dennis DT, Wormser GP. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. 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Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. The Lancet Infectious Diseases. 2018;18(3):308\u2013317.https:\/\/doi.org\/10.1016\/S1473-3099(17)30725-9.","DOI":"10.1016\/S1473-3099(17)30725-9"},{"key":"11209_CR7","doi-asserted-by":"publisher","unstructured":"Stewart\u00a0J, Oware K,\u00a0Donnell\u00a0D, Violette LR,\u00a0Odoyo\u00a0J, Soge OO,\u00a0Scoville\u00a0CW, Omollo V, Mogaka FO, Sesay FA, McClelland\u00a0S, Spinelli\u00a0M, Gandhi M, Bukusi\u00a0EA, Baeten\u00a0JM. Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women. New England Journal of Medicine. 389(25): 2331\u20132340. https:\/\/doi.org\/10.1056\/NEJMc2401273","DOI":"10.1056\/NEJMc2401273"},{"key":"11209_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12977-018-0408-3","volume":"15","author":"R Eakle","year":"2018","unstructured":"Eakle R, Venter F, Rees H. Pre-exposure prophylaxis (Prep) in an era of stalled HIV prevention: Can it change the game? Retrovirology. 2018;15:1\u201310. https:\/\/doi.org\/10.1186\/s12977-018-0408-3.","journal-title":"Retrovirology"},{"issue":"2","key":"11209_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000608","volume":"3","author":"M H\u00e5kansson","year":"2018","unstructured":"H\u00e5kansson M, Oguttu M, Gemzell-Danielsson K, Makenzius M. Human rights versus societal norms: A mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya. BMJ Glob Health. 2018;3(2): e000608. https:\/\/doi.org\/10.1136\/bmjgh-2017-000608.","journal-title":"BMJ Glob Health"},{"issue":"12","key":"11209_CR10","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1089\/apc.2018.0058","volume":"32","author":"J Pintye","year":"2018","unstructured":"Pintye J, Beima-Sofie KM, Makabong\u2019O PA, Njoroge A, Trinidad SB, Heffron RA, Baeten JM, Celum C, Matemo D, Kinuthia J, Kelley MC, John-Stewart GC. HIV-uninfected Kenyan adolescent and young women share perspectives on using pre-exposure prophylaxis during pregnancy. AIDS Patient Care STDS. 2018;32(12):538\u201344. https:\/\/doi.org\/10.1089\/apc.2018.0058.","journal-title":"AIDS Patient Care STDS"},{"issue":"1","key":"11209_CR11","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4081\/qrmh.2018.7062","volume":"2","author":"KS Hall","year":"2018","unstructured":"Hall KS, Manu A, Morhe E, Dalton VK, Challa S, Loll D, Dozier JL, Zochowski MK, Boakye A, Harris LH. 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AIDS Behav. 2022;26(1):205\u201317. https:\/\/doi.org\/10.1007\/s10461-021-03374-x.","journal-title":"AIDS Behav"},{"issue":"3","key":"11209_CR13","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25463","volume":"23","author":"J Velloza","year":"2020","unstructured":"Velloza J, Khoza N, Scorgie F, Chitukuta M, Mutero P, Mutiti K, Mangxilana N, Nobula L, Bulterys MA, Atujuna M, Hosek S, Heffron R, Bekker L, Mgodi N, Chirenje M, Celum C, Delany-Moretlwe S. The influence of HIV-related stigma on prep disclosure and adherence among adolescent girls and young women in HPTN 082: A qualitative study. J Int AIDS Soc. 2020;23(3): e25463. https:\/\/doi.org\/10.1002\/jia2.25463.","journal-title":"J Int AIDS Soc"},{"issue":"7","key":"11209_CR14","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1007\/s10461-019-02397-9","volume":"23","author":"RA Brooks","year":"2019","unstructured":"Brooks RA, Landrian A, Nieto O, Fehrenbacher A. 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AIDS Patient Care STDS. 2024;38(4):155\u201367. https:\/\/doi.org\/10.1089\/apc.2023.0289.","journal-title":"AIDS Patient Care STDS"},{"key":"11209_CR23","doi-asserted-by":"publisher","unstructured":"Stewart\u00a0J, Bukusi\u00a0E, Sesay\u00a0FA, Oware\u00a0K, Donnell\u00a0D, Soge\u00a0OO, Celum\u00a0C, Odoyo\u00a0J, Kwena\u00a0Z, Scoville\u00a0CW, Violette\u00a0LR, Morrison\u00a0S, Simoni J, McClelland RS, Barnabas\u00a0R, Gandhi\u00a0M, Baeten\u00a0JM. 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D, \"The impact of stigma on PrEP use among key populations in sub-Saharan Africa,\" BMC Public Health, vol. 21, no. 1568, p. 1\u201313, 2021."},{"key":"11209_CR36","unstructured":"H. B, \"Experiences with stigma and adherence to PrEP: Lessons learned from Brazil,\" Journal of the International AIDS Society, vol. 23, no. e25511, pp. 1\u20138, 2020."},{"key":"11209_CR37","doi-asserted-by":"publisher","unstructured":"Mon Kyaw Soe N, Bird\u00a0Y, Schwandt\u00a0M, Moraros\u00a0J. STI health disparities: A systematic review and meta-analysis of the effectiveness of preventive interventions in educational settings.\u00a0International Journal of Environmental Research and Public Health. 2018; 15(12): 2819.\u00a0https:\/\/doi.org\/10.3390\/ijerph15122819","DOI":"10.3390\/ijerph15122819"},{"key":"11209_CR38","unstructured":"M. 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R, \"PrEP stigma and trust among key populations in Kenya,\" AIDS and Behavior, vol. 23, no. 6, p. 1632\u20131639, 2019."}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11209-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-11209-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11209-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:05:58Z","timestamp":1751371558000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-025-11209-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["11209"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-11209-6","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"3 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study received ethical approval from the Scientific Ethics Review Unit at the Kenya Medical Research Institute (KEMRI) and the University of Washington\u2019s Institutional Review Board (IRB) and was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent before participation, and confidentiality was maintained throughout the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JMB is currently an employee of Gilead Sciences outside of this work. All other authors do not have competing interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"855"}}