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Background: The health challenges faced by the homeless are widely unaccounted for in the global south. In India, the lack of a primary healthcare sector in urban areas has led informal healthcare providers, such as Street Medicine, to step in. Methods: By compiling data collected by the Centre for Equity Studies’ Street Medicine teams from June 2016 to October 2018 (n =16,635), this study provides the first empirical assessment of the homeless disease burden in a global south country, while limited to only the people experiencing homelessness that the teams treat, hence being a burden of treatment. Our analysis quantifies this burden among those who seek care from Street Medicine teams and identifies variations in this burden’s distribution across demography and time. Results: The majority (n = 13,557; 81.5%) of Street Medicine cases can be attributed to 19 diagnoses or symptoms, which are mostly therapeuticallysimple conditions. The distribution of disease seems to be affected by different configurations of three characteristics: demographics (age and sex), urban geography (where homeless reside), and season. Conclusion: The Street Medicine teams must reflect on the balance they wish to achieve by addressing the relatively common and mild conditions documented in the dataset, and more severe and established diseases within homeless communities. Rapid diagnostic tests for resource-constrained settings could be integrated into Street Medicine practice in order to strengthen the data on which resource allocation decisions are made and improve assessments of homeless disease burden. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) and transgender women experience high sexually transmitted infection (STI) rates. This study evaluated the feasibility of doxycycline pre-exposure prophylaxis (doxyPrEP) for STI prevention in these key populations., Methods: Sexually-active MSM and transgender women without HIV with prior syphilis were recruited. Participants initiated HIV PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) daily for 48 weeks, and were randomized 1:1 to daily doxyPrEP for 48 weeks (immediate arm), or doxyPrEP initiated at 24 weeks (deferred arm). Primary outcomes included adherence, measured using questionnaires, along with tolerability; STI incidence (chlamydia, gonorrhea, syphilis) was a secondary outcome. Nasal carriage of S. aureus was assessed serially for doxycycline resistance., Results: Fifty-two participants were enrolled into the immediate (n=26) and deferred (n=26) arms. At 48 weeks, self-reported adherence (≥95%) was 75.0% vs. 66.7% (p=0.538) for TDF/FTC, and 70.8% vs. 61.9% (p=0.526) for doxycycline in the immediate vs. deferred arms, respectively. No doxyPrEP-related serious adverse events occurred. Incidence of any STI at 24 weeks was reduced in the immediate vs. deferred arms, and over 48 weeks, being on doxycycline (vs. being off; i.e. first 24 weeks of deferred arm) was associated with STI reduction (adjusted odds ratio [aOR] 0.36; 95 % confidence interval [CI] 0.15-0.89). Emergent doxycycline-resistant S. aureus was identified in six individuals, with five in the immediate arm (p=0.077)., Conclusions: Dual HIV/doxyPrEP is feasible and associated with a significant reduction in incident STI. Further evaluation of dosing strategies, efficacy and impact on antimicrobial resistance is warranted., (© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)