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