Optimizing Sexually Transmitted Infection Screening Packages in the Context of Doxycycline Post-Exposure Prophylaxis Use Among Cisgender Gay,Bisexual,and Other Men Who Have Sex with Men in Taiwan: A Discrete Choice Experiment

Abstract

Given the global burden of sexually transmitted infections (STIs) and the introduction of doxycycline post-exposure prophylaxis (doxy-PEP) as an effective biomedical prevention strategy, there is a need to re-evaluate and culturally tailor STI screening policies for better integration into prevention services. We assessed preferences for STI prevention services among gay, bisexual, and other men who have sex with men (GBMSM) in Taiwan in the context of doxy-PEP. An anonymous, self-administered, web-based survey was conducted between April and May 2025 via a geosocial app popular among Taiwanese GBMSM. A discrete choice experiment with a D-efficient design evaluated preferences across screening frequency, service integration, STI screening types, location, and out-of-pocket costs. Mixed logit models and latent class analysis (LCA) were used for analysis. Among 606 cisgender GBMSM (median age: 34; interquartile range: 30–40), half reported awareness of doxy-PEP, 18% had used it, and 42% were willing to use it in the next 6 months. Participants preferred fixed-interval screening, integrated prevention services (including doxy-PEP, STI screening, HIV pre-exposure prophylaxis or antiretroviral therapy, and vaccination), and lower costs. LCA identified two groups: “Cost-Conscious Pragmatists” (41%) prioritizing affordability and a simpler STI screening package (i.e., syphilis and gonorrhea), and “Comprehensive Care Self-Investors” (59%) willing to pay more for comprehensive, frequent STI screening. While GBMSM in Taiwan may favor routine, integrated services, cost strongly shapes uptake. A modular screening design with core essential services and optional add-ons could maximize accessibility and equitable access across beneficiaries with diverse financial capabilities.