Health Disparities Among Sexual and Gender Minority Adults in Ohio

Background: Many documented disparities associated with health behaviors and access to health care impact the health outcomes of sexual and gender minorities (SGM). The current study aimed to gain insight into the health dispari-ties experienced by SGM adults living in Ohio to obtain data to plan future health-related programs. Methods: A secondary data analysis was conducted using 2018 Ohio Behavior Risk Factor Surveillance System (BRFSS) data. Health behaviors, health care access, and health outcomes were analyzed by sexual orientation (n=11 301) and gender identity (n=11 426) to determine health disparities faced by sexual minority males, sexual minority females and transgender individuals. Results: Significant SGM health disparities in Ohio are related to substance use (ie, binge drinking, current smoking status, e-cigarette use, and marijuana use); poor physical and mental health status; lack of health care coverage; and experiencing COPD, emphysema, or chronic bronchitis (all p < 0.001). In addition, fewer sexual minority females reported being within recommended breast cancer screening guidelines than heterosexual females (p < 0.05). Conclusion: Sexual and gender minority adults in Ohio report disparities associated with several health behaviors and access to health care. These findings may be due to factors at the patient level (eg, experiencing minority stress), provider level (eg, implicit bias), system level (eg, discrimination), and/or society level (eg, lack of legal protections). Study results will be used to plan health campaigns and programs targeted to SGM adults and providers to achieve health equity for the SGM population in Ohio

Diversity in Digital Pill Systems: Differences in Perceptions and Attitudes Towards Use of a Digital Pill System for HIV Pre-Exposure Prophylaxis Among Men Who Have Sex With Men with Diverse Racial and Ethnic Identities

Nonadherence, particularly among men who have sex with men (MSM) with substance use disorders increases the risk of both HIV acquisition in those who are uninfected and the risk of disease progression and transmission in those with HIV. Measuring adherence to HIV pre-exposure chemoprophylaxis (PrEP) and antiretroviral therapy (ART), and responding to suboptimal adherence or changes in adherence behavior, remains a challenging public health problem. Despite the importance of accurate adherence measurement, there remains no gold standard for detecting medication ingestion events in HIV research. Technologies have been developed that indirectly infer ingestion events (e.g., via smart pill bottles) or directly measure adherence over periods of time (e.g., via drug concentration in plasma and red blood cells), yet such approaches fail to provide direct confirmation of ingestions and contextual information surrounding adherence and nonadherence. The use of a digital pill system (DPS) – a novel tool that leverages ingestible radiofrequency sensors to measure actual ingestion events – has the potential to advance adherence measurement in HIV research. In this study, we examined the willingness of MSM across racial and ethnic identities to operate a DPS in the context of PrEP adherence measurement and suggest potential future applications of this technology

Ingestible Electronic Sensors for Monitoring Real-time Adherence to HIV Pre-exposure Prophylaxis and Antiretroviral Therapy

Abstract Purpose of Review This review summarizes the recent advancements and future directions of digital pill systems (DPS) — which utilize ingestible sensors to directly measure medication ingestion events in real-time — in the context of HIV prevention and treatment. Recent Findings Two DPS are cleared by the US Food and Drug Administration. The bioequivalence and stability of digitized pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) have been established, and pilot studies have demonstrated the feasibility and acceptability of using DPS for PrEP and ART adherence measurement. Important bioethical and implementation considerations have been identified for future clinical trials. Continued technological advancement may reduce barriers to use, and integration of DPS into behavioral interventions may facilitate adherence improvement efforts. Summary DPS represent an innovative tool for PrEP and ART adherence measurement. Future work will optimize the technology to reduce operational barriers. DPS have significant potential for expansion across a diverse array of diseases, though key bioethical considerations must be examined prior to large-scale implementation

Willingness to contribute digital phenotyping data and interact with ancillary systems in the context of DPS-based research (N = 131).

Willingness to contribute digital phenotyping data and interact with ancillary systems in the context of DPS-based research (N = 131).</p

Study design and methods.

* Of 715 ineligible individuals, 343 were ineligible for more than one reason. Reasons for ineligibility included: not ≥18 years old (n = 2), not cisgender or transgender male (n = 79), does not have sex with cisgender or transgender males (n = 37), not HIV-negative (n = 101), not on PrEP (n = 367), not sexually active in the last three months (n = 67), and CAGE-AID score <2 (n = 562). ** Of 18 participants who did not pass all validity checks, 1 participant failed to pass more than one validity check. Reasons for not passing all validity checks included: age and date of birth did not match (n = 15), home zip code and home state did not match (n = 2), and IP address did not confirm current location in the US (n = 2).</p

Sociodemographic characteristics (N = 131).

Once-daily oral HIV pre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV, but is highly dependent on adherence. Men who have sex with men (MSM) who use substances face unique challenges maintaining PrEP adherence. Digital pill systems (DPS) allow for real-time adherence measurement through ingestible sensors. Integration of DPS technology with other digital health tools, such as digital phenotyping, may improve understanding of nonadherence triggers and development of personalized adherence interventions based on ingestion behavior. This study explored the willingness of MSM with substance use to share digital phenotypic data and interact with ancillary systems in the context of DPS-measured PrEP adherence. Adult MSM on PrEP with substance use were recruited through a social networking app. Participants were introduced to DPS technology and completed an assessment to measure willingness to participate in DPS-based PrEP adherence research, contribute digital phenotyping data, and interact with ancillary systems in the context of DPS-based research. Medical mistrust, daily worry about PrEP adherence, and substance use were also assessed. Participants who identified as cisgender male and were willing to participate in DPS-based research (N = 131) were included in this subsample analysis. Most were White (76.3%) and non-Hispanic (77.9%). Participants who reported daily PrEP adherence worry had 3.7 times greater odds (95% CI: 1.03, 13.4) of willingness to share biometric data via a wearable device paired to the DPS. Participants with daily PrEP adherence worry were more likely to be willing to share smartphone data (p = 0.006) and receive text messages surrounding their daily activities (p = 0.003), compared to those with less worry. MSM with substance use disorder, who worried about PrEP adherence, were willing to use DPS technology and share data required for digital phenotyping in the context of PrEP adherence measurement. Efforts to address medical mistrust can increase advantages of this technology for HIV prevention.</div