This WHO guideline recommends integrating services for hypertension, diabetes, and mental health (including depression, anxiety, and substance use) into HIV service delivery. It also provides updated recommendations on adherence support interventions shown to improve viral suppression and other health outcomes. 

The guideline offers practical implementation guidance for countries and key stakeholders as well as outlining key research gaps. As life expectancy for people living with HIV continues to increase, managing noncommunicable diseases, mental health, and adherence to antiretroviral therapy is essential to sustaining treatment success, quality of life, and engagement in care. A life course approach addresses these needs from childhood through older age. Service integration supports more person-centred, coordinated care across the life course. 

The recommendations and guidance will be included in the future update of the Chapter on HIV Service Delivery as part of the Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 

The guideline focuses on 3 main updates:

• A strong recommendation to integrate diabetes and hypertension care with HIV services. Recent estimates suggest that up to 5% of people living with HIV in sub-Saharan Africa have diabetes, and up to 25% have hypertension. This is similar to the estimates in other regions of the world;
• A strong recommendation to integrate mental health care for depression, anxiety and alcohol use disorders with HIV services. A high prevalence of mental health conditions has been reported among people living with HIV, with up to a third of people reporting symptoms of depression and/or anxiety. Alcohol use disorder is common among people with HIV, affecting at least 20% of individuals; it is associated with suboptimal medication adherence, unsafe sexual behaviour and poor mental health status; 
• Updated, evidenced-based adherence support interventions for ART, such as counselling, reminders, tailored support from peers, lay supporters and health workers, and education. These evidence-based interventions help sustain viral suppression and improve clients’ well-being by providing tailored responses to their needs.

Web annexes

• Web annex A: summary of declarations of interest (PDF, 165 kB)
• Web annex B: systematic review abstracts and GRADE evidence profiles (PDF, 550 kB)
• Web annex C: client preferences survey (PDF, 200 kB)
• Web annex D: evidence-to-decision summary of judgements (PDF, 135 kB)