A one-time programmable (OTP) bit cell includes a substrate including a front side and a back side, an active area on the front side, a first read transistor including a first gate and a first portion of the active area intersected by the first gate, a program transistor including a second gate and a second portion of the active area intersected by the second gate, a first electrical connection to the first gate, a second electrical connection to the second gate, and a third electrical connection to the active area. At least one of the first, second, or third electrical connections includes a metal line positioned on the back side.