Barriers to Digital Health Utilization and Equity Among a Community Cohort of Adults with HIV in New York City

Digital health tools are becoming increasingly essential for accessing health information, resources, and delivery of clinical care and supportive services. Recognizing the potential for digital tools to broaden access to care and monitoring and managing health conditions, a growing body of research has shown that the expansion of internet mediated health resources and services also has the potential to exacerbate rather than mitigate health inequities. The goal of this study is to examine barriers to access and effective use of digital health tools among a diverse community cohort sample of adults living with HIV in New York City. We found that one and five participants lacked access to minimal technology for digital health utilization (smartphone/computer and internet access). Digital literacy is an issue, potentially limiting use of digital tools for being in touch with providers, using patient portals, and participating in telehealth visits. Almost half of cohort members face potential digital content barriers associated with digital interfaces not designed to accommodate persons with visual, auditory, mobility, limited English language proficiency, or educational disadvantage. Concerns with providing personally identifying information online is a barrier to telehealth utilization across a range of client characteristics and life circumstances. Addressing both trust and skill-based barriers are essential to promote digital equity among people with HIV. Without intentional efforts to ensure equity, disparities will only increase among those already vulnerable.