Doxycycline Prophylaxis or Incentive Payments to Reduce Syphilis among HIV-infected Men Who Have Sex with Men

A Pilot Study

At a glance:

This pilot study will investigate the feasibility of conducting a large, randomized trial comparing a structural intervention to contingency management to reduce incident syphilis infections in an especially high risk group: HIV+ men who have sex with men (MSM) who have had syphilis twice or more since their HIV diagnosis. Subjects will be randomized to receive either QD doxycycline as syphilis prophylaxis or a financial incentive to remain STI free.

We will : 1) measure adherence to study visits in both arms; 2) measure adherence to the prophylaxis regimen; 3) measure any changes in risk behaviors among study participants and 4) to the extent possible in a small pilot study of short duration, compare effectiveness of doxycycline with that of a monetary incentive for remaining STI free.

Targeted Risk Group

 HIV+ men who have sex with men (MSM) who have had syphilis twice or more since their HIV diagnosis.

Intervention Model

Subjects will be randomized to receive either 1) Doxycycline, 100 mg. to be taken once daily or 2) an incentive for remaining STI free.

Local Significance 

Results of this study can be used to inform public health policy and programs to reduce risk of STI and HIV transmission among HIV+ “core transmitters,” and can also be easily extended to HIV negative MSM with repeated STIs. With the preliminary data from this study we hope to apply for further funding to support a larger, multisite definitive study incorporating one or both of the current interventions.