ECAPTM: 88 overall; 23 !95 adherenceSummary estimates from studies in other regions Viral load, self-report, MEMS Viral load, 1,1-Dimethylbiguanide hydrochloride cost self-report Viral load, pill count Viral load, self-report 62.3 overall adherence (95 CI 57.1 to 67.6) 83.9 overall adherence (95 CI 76.8 to 91.0) 62.0 overall adherence (95 CI 50.7 to 73.3) 62.8 overall adherence (95 CI 46.6 to 77.0)North America 22 studies fnins.2015.00094 Asia 3 studies Europe 12 South AmericaaFrom Kim et al. [91]. CI 0confidence interval; MEMS 0Medication Event Monitoring System; eCAPTM 0electronic medication vials.Adejumo OA et al. Journal of jir.2010.0097 the International AIDS Society 2015, 18:20049 http://www.jiasociety.org/index.php/jias/article/view/20049 | http://dx.doi.org/10.7448/IAS.18.1.The negative impact of civil disruptions due to political instability and violence on healthcare provision has been well documented by several researchers [143?46]. Several communities in sub-Saharan Africa have experienced significant political violence in recent decades, including the 1986 political conflicts in South Africa [147,148], and more recently, the Kenyan post-election conflicts [144,149,150]. Such situations of violence have negatively influenced health through consequences of death, disabilities, displacement and PD150606MedChemExpress PD150606 destruction of health facilities and supplies [145]. Specifically, political violence has been associated with significant disruptions in HIV patient care in Africa through widespread fear, lack of transportation, physical attacks and displacement of individuals with HIV within affected communities [144,149?51]. In communities at risk of political violence, it is helpful for HIV treatment programmes to have contingency measures, such as emergency preparedness plans in conjunction with local agencies, to forestall treatment interruptions in the event of such outbreaks [151]. Psychosocial factors The importance of social support to ART adherence has been highlighted in many sub-Saharan African studies. Fetzer et al. [136] described a strong association between caregiver supervision and ART adherence among adolescents in the Democratic Republic of Congo. Similar associations have been reported in qualitative studies among young adolescents with HIV infection and their caregivers in Kenya, Uganda and South Africa [152?54]. Among a sample of South African adolescents, those with extensive supportive networks among relatives and peers appeared to cope better with psychosocial challenges, and caregivers played an important role in facilitating ART adherence. The participants in this study opined that caregivers contributed to their good adherence by reminding them to take their medications [105]. Where caregiver involvement declines [155], the ability of hitherto dependent perinatally-infected adolescents to assume responsibility for their treatment may be threatened by developmental, psychological and social factors. Assuming responsibility for HIV treatment unlike their age mates may conflict with adolescents’ desire for peer acceptance and approval, which can be compounded by stigma, socioeconomic challenges and treatment fatigue [136,137,152]. Among horizontally-infected individuals, poor adherence has also been associated with complicated medication routines, as well as individual factors such as forgetfulness and mental health problems [85,103,156]. Psychosocial problems including non-recognition of a need for medications, fear of disclosure, poor social support and involvement in risky behaviour.ECAPTM: 88 overall; 23 !95 adherenceSummary estimates from studies in other regions Viral load, self-report, MEMS Viral load, self-report Viral load, pill count Viral load, self-report 62.3 overall adherence (95 CI 57.1 to 67.6) 83.9 overall adherence (95 CI 76.8 to 91.0) 62.0 overall adherence (95 CI 50.7 to 73.3) 62.8 overall adherence (95 CI 46.6 to 77.0)North America 22 studies fnins.2015.00094 Asia 3 studies Europe 12 South AmericaaFrom Kim et al. [91]. CI 0confidence interval; MEMS 0Medication Event Monitoring System; eCAPTM 0electronic medication vials.Adejumo OA et al. Journal of jir.2010.0097 the International AIDS Society 2015, 18:20049 http://www.jiasociety.org/index.php/jias/article/view/20049 | http://dx.doi.org/10.7448/IAS.18.1.The negative impact of civil disruptions due to political instability and violence on healthcare provision has been well documented by several researchers [143?46]. Several communities in sub-Saharan Africa have experienced significant political violence in recent decades, including the 1986 political conflicts in South Africa [147,148], and more recently, the Kenyan post-election conflicts [144,149,150]. Such situations of violence have negatively influenced health through consequences of death, disabilities, displacement and destruction of health facilities and supplies [145]. Specifically, political violence has been associated with significant disruptions in HIV patient care in Africa through widespread fear, lack of transportation, physical attacks and displacement of individuals with HIV within affected communities [144,149?51]. In communities at risk of political violence, it is helpful for HIV treatment programmes to have contingency measures, such as emergency preparedness plans in conjunction with local agencies, to forestall treatment interruptions in the event of such outbreaks [151]. Psychosocial factors The importance of social support to ART adherence has been highlighted in many sub-Saharan African studies. Fetzer et al. [136] described a strong association between caregiver supervision and ART adherence among adolescents in the Democratic Republic of Congo. Similar associations have been reported in qualitative studies among young adolescents with HIV infection and their caregivers in Kenya, Uganda and South Africa [152?54]. Among a sample of South African adolescents, those with extensive supportive networks among relatives and peers appeared to cope better with psychosocial challenges, and caregivers played an important role in facilitating ART adherence. The participants in this study opined that caregivers contributed to their good adherence by reminding them to take their medications [105]. Where caregiver involvement declines [155], the ability of hitherto dependent perinatally-infected adolescents to assume responsibility for their treatment may be threatened by developmental, psychological and social factors. Assuming responsibility for HIV treatment unlike their age mates may conflict with adolescents’ desire for peer acceptance and approval, which can be compounded by stigma, socioeconomic challenges and treatment fatigue [136,137,152]. Among horizontally-infected individuals, poor adherence has also been associated with complicated medication routines, as well as individual factors such as forgetfulness and mental health problems [85,103,156]. Psychosocial problems including non-recognition of a need for medications, fear of disclosure, poor social support and involvement in risky behaviour.