Research

Objective To estimate population-level eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) medications among adults in Australia, according to Therapeutic Goods Administration-approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity.Study TypeCross-sectional analysis of data from the Australian Bureau of Statistics 2022 National Health Survey.Setting, ParticipantsNon-pregnant adults aged ≥ 18 years who were residents of Australia living in a private dwelling.Main Outcome MeasuresTotal number of adults eligible for GLP-1RA medications according to approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity, across subgroups defined by body mass index, weight-related comorbidities and/or sociodemographic factors.ResultsOverall, 39.7% (95% confidence interval [CI], 38.4%–41.0%) of adults were eligible for GLP-1RA use for chronic weight management, accounting for 7.8 million (95% CI, 7.6–8.1 million) individuals. Among those eligible, 2.9 million (95% CI, 2.7–3.1 million) adults had no weight-related comorbidities, 3.3 million (95% CI, 3.1–3.4 million) adults had one weight-related comorbidity and 1.7 million (95% CI, 1.6–1.8 million) adults had at least two weight-related comorbidities. The proportion of adults eligible under this indication varied across clinical and sociodemographic factors. Among those eligible under the chronic weight management indication, up to 338.9 thousand (95% CI, 271.3–406.5 thousand) adults also met the indication criteria for secondary prevention of cardiovascular disease.ConclusionAbout 7.8 million Australian adults are eligible to access GLP-1RAs for chronic weight management, with up to 338.9 thousand adults also qualifying according to the indication for established cardiovascular disease. This study provides a valuable reference for policymakers to understand the number of adults in Australia who may access GLP-1RA medications based on approved indication criteria and under various coverage scenarios.

Jasmin Castrillon, Chris Schilling, Sharmala Thuraisingam, Michael W. Hii, Priya Sumithran, Peter F. Choong, Michelle M. Dowsey, Cade Shadbolt

Objective Determine whether watchful waiting is non-inferior to immediate oral antibiotics for uncomplicated acute otitis media among urban Aboriginal and Torres Strait Islander children.Study TypeNon-inferiority unblinded randomised controlled trial.Setting and ParticipantsEight Aboriginal Medical Services across three Australian states and territories between 25 August 2014 and 2 June 2023. Children (aged 1.5–16 years) with type B tympanograms and bulging tympanic membrane or acute pain/irritability were randomised by site and age (1.5–6 years and 7–16 years), with stratification using randomly allocated, permuted blocks of four and six in length.Main Outcome MeasuresWatchful waiting compared with immediate oral antibiotics using modified intention-to-treat (using only available data) and per-protocol analyses of Day 7 clinical resolution with non-inferiority threshold set at 10 percentage points.ResultsChildren were randomly allocated to watchful waiting (134), six of whom were lost to follow-up or immediate antibiotics (129) with three lost to follow-up. Resolution occurred in 57/106 (53.8%) watchful waiting and 68/113 (60.2%) immediate antibiotic group of those with complete Day 7 data (−6.4 percentage points difference; 90% confidence interval [CI], −17.4 to 4.6) (modified intention-to-treat analysis). Per-protocol analysis similarly demonstrated reduced resolution in the watchful waiting group (49/97; 50.5%) compared with immediate antibiotics (67/112; 59.8%) with −9.3 percentage points difference (90% CI, −20.6 to 2.0). There was less Day 3 diarrhoea in watchful waiting (3/90; 3.3%) than in the immediate antibiotic group (13/93 [14.0%]; −10.7 percentage points difference; 95% CI, −18.6 to −2.7) but no other differences in vomiting, diarrhoea or rash (Days 3–14). Day 7 analgesia use was higher in the watchful waiting (53/107 [49.5%]) than immediate antibiotic group (37/116 [31.9%]; 17.6 percentage points difference; 95% CI, 4.9 to 30.1). There were no intervention-related severe adverse events or perforations.ConclusionAlthough our results are numerically similar to those reported in other low-risk populations and no unexpected safety signals were observed in the watchful waiting arm, non-inferiority was not established. Larger, adequately powered trials are required to determine whether watchful waiting is non-inferior in this population.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN#12613001068752

Jennifer S. Reath, Hasantha Gunasekera, Sanja Lujic, Amanda J. Leach, Letitia Campbell, Robyn Walsh, Tim Usherwood, Geoffrey K. Spurling, Claudette A. Tyson, Deborah A. Askew, Kelvin Kong, Chelsea J. Watego, Peter Morris, Wendy Hu, Penelope A. Abbott

Objective To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment.DesignCross-sectional, population study, covering health conditions with the highest burden of disease.Setting and ParticipantsPeople in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions.Main Outcome MeasuresRelative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage.ResultsHeat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023–1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016–1.031; p < 0.001) for mental health conditions. PM2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m3 change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM2.5 (RR, 1.049 [95% CI, 1.040–1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014–1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains.ConclusionHeat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens.

Hwan-Jin Yoon, Justin Boyle, Ibrahima Diouf, Rajiv Jayasena

Objectives Develop a roadmap of contextualised strategies to support international medical graduates (IMGs) on the pathway into satisfying rural general practitioner careers in Australia.DesignRealist evaluation approach.Setting, ParticipantsOnline semi-structured interviews, focus groups and intermittent feedback cycles developed, refined and confirmed a contextualised roadmap of strategies between 1 November 2024 and 27 July 2025. Participants were purposefully selected for IMG background and different pathways into rural general practice careers across Australia. This included a 10-person project advisory group and 31 external participants covering decision-makers, training teams, supervisors and trainees. Questions explored practical strategies to drive comfort, confidence, competence, belonging and bonding.Main Outcome MeasuresContextualised strategies for IMGs to achieve satisfying rural general practice careers.ResultsThe roadmap identified that when migrating and acclimatising, providing IMGs with centralised resources and information on rural general practice training and careers promotes comfort and empowerment. When moving to new workplaces and communities, providing IMGs with supportive workplaces for early supervised practice, skill bridging and opportunities to connect with other doctors', families and communities stimulates IMG confidence, competence and sense of community belonging. When training to become a general practitioner rurally, providing IMGs with family-focused, equitable training matched to the IMG and the community, and training that builds on IMG capabilities, promotes a sense of professional belonging and bonding. We identified that early intervention and a continuity of supports are important for more comprehensively supported IMGs.ConclusionsOngoing timely support, when multi-layered, tailored and integrated, may assist IMGs to gain specialist general practice qualifications, feel valued and to settle in rural general practice roles. The roadmap provides a basis for planning coordinated longitudinal support by distributed agencies.

Belinda G. O'Sullivan, Kim J. Omond, Neysan Sedaghat

NSW Poisons Information Centre data identified 1030 deliberate prazosin self-poisonings over 11 years, rising from 13 to 170 per year (2014–2024). Young women predominated, likely due to expanded off-label (but accepted) psychiatric use of prazosin. Better evidence on benefits of off-label use is needed to justify increasing risks.

Olivia B. E. Lal, Nicholas A. Buckley, Rose Cairns

Objectives To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Study Type Cross-sectional web-based survey (February–March 2021; n=5427), compared with a similar 2012 survey (n=2686). Setting/Participants Adults (≥18years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Main Outcome Measures Asthma control test (ACT), healthcare utilisation and medications. Results Median age was 46years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT≥20: 2021, 48.0%; 2012, 54.4%; p<0.001), and more had very poorly controlled symptoms (ACT 5–15: 2021, 26.8%; 2012, 22.9%; p<0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37–1.69]; p<0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p<0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p<0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p<0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥3 inhalers in the previous year, and 10.5% obtained ≥12 inhalers. For symptom relief in the previous 4weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS–formoterol). Conclusion Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. Trial Registration ACTRN12620000977976p

Helen K. Reddel, Maria R. Ampon, Leanne M. Poulos, Sharon R. Davis, Brett G. Toelle, Guy B. Marks, Taehoon Lee

Objectives To examine the prevalence in Australia of stigmatising attitudes towards people with six different mental health conditions: depression, early and long-term/untreated forms of schizophrenia, bipolar disorder, borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD). Design Cross-sectional population-based survey using the probability-based online panel Life in Australia. Participants responded to one of six vignettes describing a person with a mental health condition. Setting Australia, 11–25 November 2024. Participants Representative sample of 6032 adult residents of Australia. Main Outcome Measures Proportions of participants who agreed or strongly agreed with 13 stigmatising attitudes and proportions who were definitely or probably unwilling to interact in five different social situations with the person in the vignette. Results Stigmatising attitudes were generally lowest for depression and highest for long-term schizophrenia and borderline personality disorder. Beliefs about unpredictability had the highest endorsement: 61.9% (95% confidence interval [CI], 58.2%–65.5%) for long-term schizophrenia; 56.3% (95% CI, 52.5%–59.9%) for borderline personality disorder; 52.8% (95% CI, 49.0%–56.6%) for early schizophrenia; 50.7% (95% CI, 47.0%–54.4%) for bipolar disorder; 29.2% (95% CI, 25.9%–32.7%) for ADHD and 23.3% (95% CI, 20.2%–26.7%) for depression. Forcing treatment was endorsed by 25.9% (95% CI, 22.6%–29.5%) for early schizophrenia and 24.1% (95% CI, 21.0%–27.6%) for long-term schizophrenia. For all conditions, at least 20% of participants did not agree that the person in the vignette was a person of worth, with agreement ranging from 78.5% (95% CI, 75.1%–81.6%) for early schizophrenia to 67.4% (95% CI, 63.8%–70.9%) for long-term schizophrenia. There were high levels of unwillingness for the person in the vignette to marry into the family: ranging from 29.7% (95% CI, 26.4%–33.2%) for ADHD to 64.4% (95% CI, 60.7%–67.9%) for long-term schizophrenia. Conclusions Stigma related to mental health conditions remains prevalent in Australia and contributes to social and economic exclusion among those affected. Sustained action is needed across multiple sectors to address stigma, particularly towards conditions such as schizophrenia and borderline personality disorder, which are poorly understood within the community.

Amy J. Morgan, Anna M. Ross, Gayle McNaught, Rachel Green, Nicola J. Reavley

Objective To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care. Design and Setting Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021). Participants Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population). Main Outcome Measure Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016–2017 to 2022–2023). High continuity was defined as having ≥70% of visits with one provider. Results About one-third of the population had high continuity of care (range: 31.3% in 2018–2019 to 37.2% in 2020–2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥70years vs. 0–14years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43). Conclusion While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care.

Rosemary J. Korda

Objective This study quantifies the short-term risk profiles of seven severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) vaccines—Comirnaty Bivalent BA.1, Comirnaty Bivalent BA.4-5, Comirnaty XBB.1.5, Spikevax Bivalent BA.1, Spikevax Bivalent BA.4-5, Spikevax XBB.1.5 and Nuvaxovid—administered as booster doses in Australia. Design This is a survey study using data collected from online surveys sent via AusVaxSafety, the Australian active vaccine safety surveillance system, 3days post-vaccination, soliciting reports of adverse events following vaccination. Participants and Setting Individuals 18years and older who received a SARS-CoV-2 vaccine booster at an AusVaxSafety vaccine surveillance site between 1 January 2023 and 31 August 2024. Main Outcome Measures Bayesian logistic regression was used to estimate risk of reported adverse events, seeking medical advice and impact on daily activities. Results Of 197,476 respondents, 59,089 (29.9%) reported at least one adverse event, of which the most commonly reported symptoms were injection site reaction (23.8% [46,988/197,476]) and fatigue (19.4% [38,352/197,476]). Symptom resolution was reported by 69.9% (41,299/59,089) by day 3 and 5.6% (11,006/197,476) reported any time lost from daily activities. The unadjusted proportion of respondents who sought medical advice was higher in those who received Spikevax XBB.1.5 (1.2% [212/17,551]) than the other vaccines (0.5% [379/69,493] to 0.7% [147/20,271]), but the modelled, adjusted mean risk of medical advice was similar (<2.5%) across subgroups for vaccine brands, co-administered vaccines, medical conditions, age, sex and Indigenous status. The modelled risk of any adverse event at age 40years ranged from 35.2% (95% credible interval [CrI], 32.2%–38.5%) for men who had received Comirnaty XBB.1.5 to 75.5% (95% CrI, 71.9%–78.8%) for women who had received Spikevax XBB.1.5. At age 80years, this risk was lowest across all vaccines, ranging from 12.0% (95% CrI, 11.2%–13.0%) for men who had received Comirnaty BA4-5 to 36.7% (95% CrI, 34.6%–38.7%) for women who had received Spikevax XBB.1.5. Conclusions The results of this study confirm the short-term safety and low impact on daily living of SARS-CoV-2 booster vaccine administration to Australian adults.

Evelyn Tay, Michael Dymock, Lucy Dawes, Lucy Deng, Thuy Nguyen, Alan Leeb, Julie A. Marsh, Nicholas Wood, Kristine Macartney, Thomas L. Snelling

Objectives To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Study Type Retrospective observational cohort study. Setting Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Participants Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Main Outcome Measures Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. Results There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33years (standard deviation [SD], 7.4years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426–$34,544). Conclusion Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons.

Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark

Objectives To examine the effects of social media on future mental health problems (depressive symptoms, anxiety symptoms, poor well-being and self-harm) in adolescents aged 12–18years, overall and stratified by sex and age periods (early, middle and late adolescence).Study TypeProspective longitudinal study.SettingParticipants were recruited in 2012 through schools in Melbourne, selected using stratified random sampling. In wave 1 (2012), 1239 Grade 3 students participated and have since completed annual surveys.ParticipantsThe analysis used data up to wave 11 (2022). Participants with no data on mental health, social media and confounders were excluded, leaving a sample of 1195 (552 [46%] male participants).Main Outcome MeasuresExposure was self-reported duration of daily social media use at each wave, from waves 4 to 10 (ages 12–18years). Outcomes (self-reported depressive symptoms, anxiety symptoms, well-being, self-harm) were assessed at the subsequent annual wave, from waves 5 to 11 (ages 13–19years).ResultsAcross adolescence, >2h versus <1h of daily social media use was associated with a small increase in risk of high depressive symptoms (risk difference [RD] per 100, 6.3 [95% CI, 2.7–9.9]) and poor well-being (RD, 4.9 [95% CI, 1.1–8.6]) at the subsequent annual wave. Estimated risks for all mental health problems were greatest in early adolescence (12–13years), with the largest effects observed for high depressive symptoms in female participants (>2h vs. <1h: RD, 10.8 [95% CI, 2.7–18.9]).ConclusionsHigher levels of social media use were associated with small increases in future risk of high depressive symptoms and poor well-being across adolescence. The largest risks for all mental health problems were observed during early adolescence for both male and female participants, supporting the need to consider policies that mitigate the adverse effects of social media on the mental health of younger adolescents.

Nandita Vijayakumar, S. Ghazaleh Dashti, Louise Canterford, Susan Ellul, Anthony J. A. Parissi, Anne-Lise Goddings, Russell M. Viner, Paul Moran, Rohan Borschmann, Lisa K. Mundy, Ellie M. Robson, Susan M. Sawyer

The 2025 NSW RSV Prevention Program, which achieved an estimated coverage of 63% maternal vaccination and 18% for infant immunisation, led to more than 40% reduction in RSV notifications and hospitalisations among infants aged younger than 6months.

Janaki Amin, Sally L. Ellis, Christopher Lambeth, Jessica Gugusheff, Christine Selvey

Objectives To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives. Design A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care. Setting, Participants Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER-ALZ eligibility criteria: mean age 75years, amyloid-β-positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with APOEE4 homozygotes, in line with the Australian labelling. Donanemab administered every 4weeks with magnetic resonance imaging (MRI)-based amyloid-β-related imaging abnormalities monitoring and treatment suspension upon amyloid-β clearance or progression to severe Alzheimer disease, compared with standard care. Main Outcome Measures Incremental costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses. Results Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness-to-pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure. Conclusion Donanemab provides clinical benefits but is unlikely to be cost-effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real-world evidence and disaggregated analyses by geography and socioeconomic status is warranted.

Lan Gao, Rosie Watson, Nawaf Yassi

Objective To examine the awareness, usage and perceptions of doxycycline post-exposure prophylaxis (doxyPEP) for sexually transmitted infection (STI) prevention among gay and bisexual men and transgender (trans) and gender diverse people in Australia. Design Cross-sectional online survey. Setting, Participants National multi-site survey in Australia from 1 July 2024 to 30 November 2024, recruiting from 13 sexual health and community clinics, 6 general practices, social media, dating applications, and university portals. Gay and bisexual men and trans and gender diverse people aged ≥18years living in Australia were included in the study. Main Outcome Measures DoxyPEP awareness, ever use, recent use (past 12months), dosage regimens, sourcing methods and planned future use. Results Among 2095 participants, half (1080/2095, 51.6%) had heard of doxyPEP. Of those aware, 323/1080 (29.9%) had ever used doxyPEP, and 306/1080 (28.3%) were recent users. DoxyPEP awareness and usage varied by HIV status and pre-exposure prophylaxis (PrEP) use (p<0.0001). Nearly two-thirds of users had taken the recommended 200mg within 72h after sex (205/323, 63.5%). Among recent users, 29/306 (9.5%) reported recent syphilis diagnoses, and 85/306 (27.8%) had ≥2 STI diagnoses in the past 12months. Of those who had ever used doxyPEP, 135/323 (41.8%) obtained prescriptions from clinicians, 17/323 (5.3%) obtained it online, and 28/323 (8.7%) purchased it in person overseas without a prescription. Of those aware of doxyPEP, 490/1080 (45.4%) planned to use doxyPEP in the next 12months, primarily to prevent chlamydia (460/490, 93.9%), gonorrhoea (422/490, 86.1%) or syphilis (386/490, 78.8%). Some intended to prevent Mycoplasma genitalium (92/490, 18.8%) or mpox (36/490, 7.4%). Among non-users, 306/756 (40.5%) worried about antibiotic resistance. Conclusions DoxyPEP use was happening quickly but often involved non-recommended regimens and unsupervised sourcing. Urgent educational interventions and improved clinical access are needed for safe implementation.

Catriona S. Bradshaw, Dash Heath-Paynter, Benjamin Riley, Daniel Grace, Fabian Y. S. Kong, Eric P. F. Chow