Coping strategies and associated factors in adolescents with HIV following disclosure of their HIV status at Arua Regional Referral Hospital

Abstract

Background: Disclosure is part of the HIV/AIDS care for adolescents and is one of the greatest psychosocial challenges that HIV-infected adolescents face. It is important to know the coping strategies used by adolescents living with HIV following disclosure of their HIV status in addition to psychosocial challenges that they have. There is limited data about coping strategies in HIV infected adolescents in low-income countries like Uganda and associated factors. Objective: To describe the coping strategies of adolescents with HIV and associated factors with these coping strategies following disclosure of their HIV status at Arua Regional Referral Hospital. Methodology: A cross-sectional study with mixed methods (quantitative and qualitative) of data collection was used. It involved 204 adolescents aged 10-19 years living with HIV and receiving care at the Arua Regional Referral Hospital HIV clinic who knew their status. The Brief COPE tool and a questionnaire were used for the quantitative data collection. The qualitative component included in-depth interviews with 20 adolescents and 8 Key informant interviews with health workers and peers working at the clinic. Quantitative data was entered in Epidata 3.1 then exported to the STATA version 14 to analyse univariate frequencies, contingency tables, measures of centrality, mean and standard deviations (SD). The Mann Whitney test, t test and ANOVA were used to compare the mean scores of the coping strategies and independent variables. Association between coping strategies and variables was determined using linear regression. Spearman correlation test was used to analyse continuous variables where a p < 0.05 was considered statistically significant. Audio recorded interviews were transcribed and analysed using content thematic approach. Results: Adolescents used more adaptive coping strategies (mean 43.72±7.89) than maladaptive coping strategies (mean 25.46±5.77). Qualitative findings revealed increased use of adaptive coping strategies with time following disclosure. Instrumental support (mean 6.26±1.58) and emotional support (mean 6.06±1.65) were the most common adaptive coping strategies while venting (mean 4.96±1.58) and denial (mean 4.22±1.80) were the most common maladaptive coping strategies. Use of family support, acceptance and religion were the adaptive coping strategies in the qualitative results while self-distraction, self-blame, blaming others and anger were the maladaptive coping strategies used. Having a caregiver who’s not the parent (adjusted coefficient 2.5, 95% CI (0.25- 4.82), p = 0.03) and family support (adjusted coefficient 5.35, 95% (3.12- 7.57), p = 0.000) were associated with adaptive coping while viral load non suppression (adjusted coefficient 2.03, CI (0.49- 3.68) p = 0.011) and alcohol use (adjusted coefficient 4.85, CI (2.99- 6.72), p = 0.000) were associated with maladaptive coping. Being a member of the peer support group, having family support, education and ARV use were cited by key informants and adolescents as associated factors for use of adaptive coping strategies while lack of family support, stigma and ARV use were cited as associated factors for use of maladaptive coping strategies. Conclusion: Adolescents with HIV mainly used adaptive coping strategies. Factors associated with adaptive coping included emotional family support, being a member of a peer support group, tackling stigma, viral suppression, relationship to the caregiver. Maladaptive coping was associated with stigma, lack of family support, alcohol use, viral load non-suppression. Strengthening family support is key in improving coping among adolescents following disclosure in a low resource-limited setting.