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Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study

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Abstract

Little is known about HIV medication concealment behaviors and the effect of medication concealment on antiretroviral therapy (ART) adherence among people with HIV (PWH). This study aims to (1) to describe medication concealment behaviors and factors associated with these behaviors, and (2) assess the association between medication concealment and suboptimal ART adherence. The Florida Cohort Study enrolled adult PWH from community-based clinics around the state from October 2020 to September 2022 (n = 416, 62% aged 50+, 56% male, 44% non-Hispanic Black, 18% Hispanic). Participants responded to questions about sociodemographics, stigma, ART adherence (≥ 85%), symptoms of depression, social networks and disclosure to their networks, and actions to conceal ART to avoid inadvertent disclosure of their HIV status. Analyses were conducted using multivariable logistic regressions models. The most common concealment behavior was hiding ART while having guests over (32%), followed by removing ART labels (26%), and putting ART into a different bottle (16%). Overall, 43% reported ≥ 1 behavior. In multivariable models, depressive symptoms, incomplete disclosure of HIV to close social networks, and not having a close social network were associated with ART concealment. After adjusting for risk factors for suboptimal ART adherence, endorsing hiding medication while having guests was associated with suboptimal ART adherence (aOR 2.87, 95% CI 1.15–7.55). Taking any action and other individual behaviors were not associated. ART concealment behaviors were common but did not consistently negatively influence adherence when accounting for other factors. PWH may want to receive ART medications in ways that ensure privacy and reduce the risk of inadvertent disclosure.

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Data and Code Availability

The data used in this study can be requested from the Southern HIV and Alcohol Research Consortium (https://sharc-research.org/research/data/sharc-concepts-system/) and the code can be provided by the corresponding author upon request.

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Acknowledgements

The authors would like to thank Dr. Zhigang Li and Seungjun Ahn for their advice on the statistical analyses. We would also like to thank the Florida Cohort coordination and recruitment team, especially Edwige Nicholas, and the study participants.

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (grants T32AA025877, F31AA030518, U24AA022002).

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA

    Rebecca J. Fisk-Hoffman, Christina E. Parisi, Nanyangwe Siuluta, Delaney D. Ding & Robert L. Cook

  2. Unconditional Love Incorporated, Melbourne, FL, USA

    Maya Widmeyer

  3. Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA

    Charurut Somboonwit

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Conceptualization: Fisk-Hoffman, Parisi, Siuluta, Ding, Cook; Methodology & Formal Analysis: Fisk-Hoffman; Writing-Original Draft: Fisk-Hoffman, Parisi, Siuluta, Ding; Writing-Review & Editing: Fisk-Hoffman, Parisi, Siuluta, Ding, Widmeyer, Somboonwit, Cook; Supervision: Cook.

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Correspondence to Robert L. Cook.

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Fisk-Hoffman, R.J., Parisi, C.E., Siuluta, N. et al. Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study. AIDS Behav 28, 1047–1057 (2024). https://doi.org/10.1007/s10461-023-04214-w

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