Self-care and Off-label Doxycycline Post-exposure Prophylaxis Among Men Who Have Sex With Men in Brazil: A Qualitative Study.

Participants relied on informal information networks, rather than formal health services, to learn about and decide to use Doxy-PEP.

• Reliance on informal information networks was one of four interrelated themes identified.
• The study included 32 cisgender men aged 18 years or older who reported Doxy-PEP use.
• Data were collected via an online semi-structured questionnaire and analyzed with reflexive thematic analysis.

Participants experienced ethical and biomedical tensions about Doxy-PEP use, including concerns about antimicrobial resistance.

• Ethical and biomedical tensions formed one of the four themes.
• Antimicrobial resistance concerns were explicitly named within this theme.
• The analysis was guided by Orem's Self-Care Theory and the health vulnerability framework.

Participants managed Doxy-PEP pharmacologically on their own, obtaining the drug through informal or negotiated access.

• Pharmacological self-management through informal or negotiated access was one of the four themes.
• Use occurs in Brazil without formal clinical protocols for Doxy-PEP, i.e., off-label use.

Weak institutional support led participants to follow alternative therapeutic itineraries for Doxy-PEP.

• Weak institutional support leading to alternative therapeutic itineraries was the fourth theme.
• The absence of formal protocols shifts prevention responsibility to individuals.

Doxy-PEP use is characterized as a situated self-care practice shaped by intersecting vulnerabilities and institutional gaps.

• This interpretation was derived through Orem's Self-Care Theory and the health vulnerability framework.
• The authors conclude there is a need for equitable, evidence-based nursing interventions for STI prevention.