A Group Concept Mapping Study of Client and Clinician Perspectives on Scaling up HIV PrEP and doxy-PEP in Primary Care

Abstract

The rising incidence of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), among sexual and gender minorities (SGMs) remains a significant public health concern. As biomedical prevention strategies such as HIV preexposure prophylaxis (PrEP) and doxycycline postexposure prophylaxis (doxy-PEP) for bacterial STIs continue to emerge, expanding access beyond specialized infectious diseases and sexual health settings is critical. Primary care, given its broad reach and continuity of care, is well positioned to integrate STI and HIV prevention services and improve equitable access to these interventions. We used group concept mapping with distinct stakeholder groups, including SGM clients and primary care clinicians, to (1) identify client-perceived strategies that facilitate awareness, uptake, and persistence of PrEP and doxy-PEP in primary care; (2) identify clinician-perceived strategies that support these outcomes; and (3) determine shared priorities for integrating biomedical prevention into primary care practice. Six thematic clusters emerged, representing key domains for effectively increasing PrEP and doxy-PEP use in primary care. Across clusters, 49 strategies were rated highly on both importance and feasibility. Highly prioritized strategies emphasized nonjudgmental patient education during routine visits, increasing access to SGM-affirming clinicians, fostering welcoming clinical environments, and strengthening health professional education on both biomedical prevention and SGM-specific health needs. This study offers a stakeholder-informed framework to guide the integration of biomedical STI and HIV prevention into primary care. Future research should focus on the implementation, evaluation, and sustainability of these strategies to optimize prevention uptake and persistence in primary care settings.