Clinical Scorecard: Using Sexual Orientation and Gender Identity Data to Identify Disparities in HIV Preexposure Prophylaxis
At a Glance
Category
Detail
Condition
HIV preexposure prophylaxis (PrEP) disparity measurement using sexual orientation and gender identity (SOGI) data
Key Mechanisms
The study compares detection of disparities in documented PrEP medication orders when surveillance uses complete SOGI data, sex assigned at birth (SAAB) alone, or simulated incomplete SOGI data.
Target Population
Adults in a Southern California safety-net health system with classifiable SAAB, sexual orientation, and gender identity data; final sample of 165,198 patients.
Care Setting
Electronic health record surveillance in a safety-net integrated delivery system; the study evaluates measurement of disparities rather than clinical treatment.
Key Highlights
The analysis held the population and PrEP-order outcome constant while varying the SOGI information available to surveillance.
The three scenarios were complete SOGI data, SAAB-only monitoring, and simulated joint SOGI missingness from 0% to 90%.
The outcome was any EHR-documented PrEP medication order dated through October 27, 2025.
The authors describe incomplete SOGI capture as a limitation on identifying and tracking disparities among sexual and gender minority groups.
The source population included 180,662 registered patients; the final adult analytic sample included 165,198 with classifiable SOGI values.
Guideline-Based Recommendations
Diagnosis
Not a diagnostic study; it assessed surveillance of documented PrEP medication orders by identity group.
Management
No clinical treatment recommendations are reported in the provided article text.
Monitoring & Follow-up
The study evaluates disparity monitoring under complete SOGI, SAAB-only, and simulated incomplete-SOGI data conditions.
Structured SOGI collection began in 2021, and completeness for both SOGI fields exceeded 95% by 2023 in this health system.
Risks
The authors state that incomplete or absent SOGI data can constrain equity monitoring and leave disparities undetected.
SAAB-only stratification may conceal heterogeneity between groups with different HIV risk and prevention needs, according to the article.
Patient & Prescribing Data
Adults aged 18 years or older in a Southern California safety-net system with classifiable SAAB, sexual orientation, and gender identity; 165,198 patients were included.
The study measured whether any PrEP medication order was documented in the EHR by October 27, 2025. The provided text does not report order rates or comparative results.
Clinical Best Practices
For disparity surveillance, the study compares identity-specific measurement using complete SOGI data with SAAB-only and incomplete-data scenarios.
Interpret the study outcome as documented EHR medication orders; registration and first-encounter dates were unavailable, so observation duration could differ among patients.
The article reports adjustment for age, race, and ethnicity in adjusted analyses.
