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

  • The Science of Prevention (JD Stekler and J Baeten, Section Editors)
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA, 02120, USA

    Ingrid T. Katz

  2. Harvard Medical School, Boston, MA, USA

    Ingrid T. Katz & David R. Bangsberg

  3. Massachusetts General Hospital Center for Global Health, Boston, MA, USA

    Ingrid T. Katz & David R. Bangsberg

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  1. Ingrid T. Katz
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  2. David R. Bangsberg
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Correspondence to Ingrid T. Katz.

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Ingrid T. Katz and David R. Bangsberg declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This publication was made possible with funding from US National Institute for Mental Health K23 MH097667 (Katz). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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This article is part of the Topical Collection on The Science of Prevention

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Katz, I.T., Bangsberg, D.R. Cascade of Refusal—What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa?. Curr HIV/AIDS Rep 13, 125–130 (2016). https://doi.org/10.1007/s11904-016-0309-9

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