All ETDs from UAB

Advisory Committee Chair

Gerald McGwin Jr

Advisory Committee Members

Russell L Griffin

Kimberly D Martin

Michael J Mugavero

James H Willig

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


HIV remains a major ongoing public health problem globally and in the United States (US). Despite the advances in the antiretroviral therapy (ART), new HIV cases continue to occur. Hence, understanding the factors that influence patient’s decision to HIV treatment and prevention is of paramount. HIV disclosure, an important modifiable behavior, is a barrier to linkage and engagement in HIV care. Thus far, studies examining HIV disclosure and its impact on HIV related outcomes, retention in care (RIC) and viral load (VL) suppression among HIV patients newly initiating care are scant. While these studies provide insights on risk factors of HIV disclosure and its impact of HIV related outcomes to some extent, they are limited to examining few risk factors of HIV disclosure and different ascertainment of HIV disclosure generating inconsistent results. Additionally, the majority of the studies conducted have HIV cohorts with enrollment not restricted to couple of weeks from initiating care. The aim of this dissertation was to assess factors associated with HIV disclosure/patterns of HIV disclosure and its impact on RIC and VL suppression. Using new to HIV care integrating ENGagement and Adherence Goals upon Entry (iENGAGE) data, we observed that Black race, emotional support, and unmet needs predicted any HIV and broad disclosure, whereas males, emotional support, active coping and acceptance were associated with selective disclosure. We observed that HIV disclosure and patterns of disclosure did not significantly improve RIC and 48-week VL suppression. However, any disclosure, broad and selective disclosure groups were significantly less likely to achieve VL suppression over time. Finally, we did not observe effect modification by HIV disclosure and patterns of HIV disclosure on the relationship of iENGAGE intervention with 48-week VL suppression. In conclusion, this dissertation contributes to the existing knowledge of early HIV disclosure and HIV related outcomes among patients initiating care.

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