Cascade of Refusal—What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa?

Ingrid T. Katz, David R. Bangsberg

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Recent recommendations by the World Health Organization support treatment for all people living with HIV (PLWH) globally to be initiated at the point of testing. While there has been marked success in efforts to identify and expand treatment for PLWH throughout sub-Saharan Africa, the goal of universal treatment may prove challenging to achieve. The pre-ART phase of the care cascade from HIV testing to HIV treatment initiation includes several social and structural barriers. One such barrier is antiretroviral therapy (ART) treatment refusal, a phenomenon in which HIV-infected individuals choose not to start treatment upon learning their ART eligibility. Our goal is to provide further understanding of why treatment-eligible adults may choose to present for HIV testing but not initiate ART when indicated. In this article, we will discuss factors driving pre-ART loss and present a framework for understanding the impact of decision-making on early losses in the care cascade, with a focus on ART refusal.

Original languageEnglish (US)
Pages (from-to)125-130
Number of pages6
JournalCurrent HIV/AIDS Reports
Issue number2
StatePublished - Apr 1 2016


  • ART refusal
  • Antiretroviral medications
  • Global epidemic
  • HIV prevention
  • Point of testing
  • Review
  • Science of prevention
  • Treatment refusal

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases


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