Models and Implementation Approaches for Integrating Mental Health Services into HIV Care in Sub-Saharan Africa: A Scoping Review

Abstract Mental-health conditions are common among people living with HIV and can complicate adherence, retention, quality of life and engagement with care. In sub-Saharan Africa, however, specialist mental-health capacity remains limited while HIV programmes have developed extensive chronic-care platforms. Integrating mental-health support into HIV services therefore offers a pragmatic route to reduce the treatment gap. Following PRISMA-ScR guidelines, this study review mapped recent models for integrating mental-health services into HIV care in sub-Saharan Africa, examined their delivery architecture and outcome patterns, and identified implementation priorities for scale-up. A structured evidence-mapping approach was applied to peer-reviewed literature published from 2020 to 2026. Recent scoping/systematic reviews were used as anchor sources, followed by a focused update search of PubMed and publisher-indexed scholarly sources and citation chaining. Evidence was charted by country, population, care setting, delivery cadre, clinical target, model of integration, mental-health outcomes, HIV outcomes and implementation findings. Results: The recent evidence clustered around five service models: task-shared brief psychological care; collaborative stepped care; peer-led or youth-differentiated care; integrated screening with tiered referral; and group/community-based psychotherapy. Zimbabwe, South Africa and Uganda accounted for much of the evaluative literature, with emerging implementation evidence from Malawi, Cameroon, Nigeria and Kenya. Mental-health outcomes generally improved when interventions contained an active therapeutic component and adequate supervision, but effects on ART adherence and viral suppression were inconsistent. Malawi's routine programme demonstrated that high screening coverage can be achieved inside ART clinics, whereas studies in Cameroon and Nigeria highlighted workforce, privacy, referral and leadership constraints. Conclusion: The strongest model is not simple co-location. Effective integration combines routine identification, low-intensity task-shared treatment, measurement-based follow-up, clear escalation pathways, adherence-specific support and sustained supervision. Future research should test implementation at scale, cost, equity, severe mental illness and long-term HIV endpoints across underrepresented sub-Saharan African settings.