World Health Organization · 2025 edition · 56 pages
Updated WHO recommendations on integrating chronic disease and mental health care into HIV services and supporting long-term adherence to antiretroviral therapy
- Issuer
- World Health Organization
- Edition
- 2025 edition
- Audience
- Policy-makers, national HIV programme managers, primary health care providers, nurses, community health workers, implementing partners, civil society organizations
- Evidence
- GRADE-rated recommendations based on systematic reviews and meta-analyses of 228 studies (18 on integration of diabetes/hypertension, 46 on mental health integration, 164 on adherence interventions); values and preferences survey; cost-effectiveness analyses
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guideline provides updated recommendations for delivering comprehensive, integrated services to people living with HIV. As antiretroviral therapy has transformed HIV into a chronic condition for over 31 million people globally, new challenges have emerged: managing comorbid noncommunicable diseases (diabetes, hypertension), addressing mental health needs (depression, anxiety, alcohol use disorders), and sustaining lifelong treatment adherence.
The guideline now strongly recommends integrating diabetes and hypertension care with HIV services (upgraded from a conditional recommendation in 2021) and introduces a new strong recommendation to integrate mental health care for depression, anxiety and alcohol use disorders into HIV services. It also updates the 2016 recommendation on adherence support, reaffirming that structured interventions—counselling, reminders, peer support, and education—should be provided to all people on antiretroviral therapy.
These recommendations are based on systematic reviews of over 200 studies, predominantly from sub-Saharan Africa, demonstrating that integration improves blood pressure control, reduces depression, and enhances viral suppression without added harm. The guideline emphasizes person-centred, differentiated service delivery models that can be adapted to local contexts, with implementation considerations for task-sharing, digital tools, community engagement, and cost-effectiveness.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Diabetes and hypertension care should be integrated with HIV services (strong recommendation; rates of blood pressure control improved with odds ratios ranging from 1.3 to 26.5 across studies, translating to 46–634 more per 1000 achieving control)
- Mental health care for depression, anxiety and alcohol use disorders should be integrated with HIV services (strong recommendation; integration led to large reductions in moderate-to-severe depression with OR 0.5, 95% CI: 0.3–0.7)
- Adherence support interventions should be provided to all people on ART (strong recommendation), with demonstrated benefit from counselling (OR 1.3), reminders (OR 1.6), and peer/other support (OR 1.3) for improving adherence and viral suppression
- For adolescents and young people, reminders are particularly effective for viral suppression (OR 2.9, 95% CI: 1.6–5.6)
- For individuals with adherence challenges, peer supporters (OR 4.8, 95% CI: 2.0–12.2) and counselling (OR 1.8, 95% CI: 1.0–3.5) may improve adherence
- Enhanced adherence support should be provided to all individuals with initial viral load >1000 copies/mL before conducting second viral load test (some national guidelines use >50 copies/mL threshold)
- Services should be decentralized to primary care with multi-month dispensing (3–6 monthly clinical visits for stable patients; WHO supports multi-month ART dispensing)
- Integration of HIV, diabetes and hypertension services reduces costs by 34.4% (95% CI: 17.9–41.9%) when managing two conditions and 48.8% (95% CI: 42.1–55.3%) when managing all three compared to separate care
Summary of new and updated recommendations
Table extracted from the guideline
| Recommendation type | Recommendation | Strength and certainty of evidence |
|---|---|---|
| Updated (from 2016) | Diabetes and hypertension care should be integrated with HIV services | Strong recommendation, moderate certainty for blood pressure control / very low certainty for diabetes control |
| New | Mental health care for depression, anxiety and alcohol use disorders should be integrated with HIV services | Strong recommendation, moderate certainty for depression / low certainty for anxiety and alcohol use |
| Updated (from 2016) | Adherence support interventions should be provided to people on ART: counselling, reminders, tailored support from peers/lay persons/health workers, education | Strong recommendation, moderate certainty for counselling/reminders/tailored support; low certainty for education |
Source: World Health Organization, Guideline on HIV service delivery: integration of diabetes, hypertension and mental health services, and adherence support interventions. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- Diabetes and hypertension integration upgraded from conditional (2021) to strong recommendation based on new evidence from 18 studies showing improved blood pressure control
- New strong recommendation for mental health integration (depression, anxiety, alcohol use) based on evidence from 46 studies
- Adherence support recommendation updated to reflect evidence from 164 randomized trials conducted since 2016, with refined categorization of interventions (reminders, peer/other supporters, counselling, education)
- Emphasis on differentiated service delivery models with multi-month dispensing and task-sharing approaches
- Specific guidance added for vulnerable populations (adolescents, people with mental health conditions, substance users)
From the guideline
Verbatim
“Integrated service delivery is critical to supporting expanded access to a broad range of essential services.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and someone who has worked extensively on health system strengthening in our region, I find these updated WHO recommendations highly relevant for the South Caucasus. Georgia has demonstrated that vertical disease programmes can be successfully integrated into universal health coverage—we did this with hepatitis C elimination starting in 2015, achieving remarkable results. The evidence here is compelling: integrating HIV, NCD and mental health services not only improves clinical outcomes but reduces costs by up to 49%, which is critical for sustainability in middle-income settings like ours. I would particularly stress to Georgian clinicians the strong evidence for structured adherence support interventions—our HIV cohort is aging, and long-term retention requires systematic approaches to counselling and peer support, not just medication dispensing. The realistic caveat for implementation in Georgia and neighbouring countries is that we must first address the fragmented financing of NCD medications and mental health services; unlike antiretrovirals, diabetes and hypertension drugs often require out-of-pocket payment, and mental health services remain under-resourced in primary care, which will limit the equity gains promised by integration unless policy reforms accompany service delivery changes.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s health system, which has implemented universal health coverage since 2013 and successfully scaled the hepatitis C elimination programme, is well-positioned to adopt integrated HIV service delivery. With an estimated HIV prevalence concentrated among key populations and aging of the HIV cohort, integration of NCD and mental health screening into existing HIV services would align with Georgia’s primary health care strengthening initiatives. National programmes will need to assess the feasibility of task-sharing policies (currently variable across the region), ensure uninterrupted supply chains for diabetes and hypertension medications (which may require out-of-pocket payment in some settings), and adapt digital reminder systems to local telecommunications infrastructure. The cost-savings demonstrated (34–49% reduction when integrating two or three conditions) are particularly relevant for resource-optimization in the South Caucasus context, though implementation will require training primary care providers and community health workers in chronic disease management and creating linkages between vertical HIV programmes and general health services.
Questions this guideline answers
Quick answers
What does 'integration' of services actually mean in practice?
Integration can range from close collaboration between services to fully integrated chronic disease management. At minimum, it means providing standardized care for HIV, diabetes, hypertension and/or mental health conditions in the same setting where clients receive HIV services, with coordinated appointment scheduling, aligned clinical visits (every 3–6 months for stable patients), and multi-month dispensing of all medications together. The level of integration should be adapted to local context—it can involve adding NCD/mental health screening to existing HIV clinics or creating chronic disease clinics that serve people with or without HIV.
Which adherence interventions are most effective and for whom?
For the general adult population, reminders (SMS, apps) show the strongest effect (OR 1.6 for adherence, large improvements in viral suppression), followed by peer/other supporters (OR 1.3) and counselling (OR 1.3). For adolescents, reminders are particularly effective (OR 2.9 for viral suppression). For individuals with prior adherence challenges, peer supporters (OR 4.8) and counselling (OR 1.8) work best. For people with mental health conditions, supporters show greatest benefit (OR 2.4 for viral suppression). Interventions should be tailored, combined or sequenced based on individual barriers and preferences, with particular attention during the first months after diagnosis when disengagement is most likely.
How can countries implement integrated services with limited resources?
The guideline emphasizes task-sharing to non-physician health workers and community members, which is supported by WHO hypertension and mhGAP guidelines. Costs can be reduced through differentiated service delivery (less frequent visits for stable patients), multi-month medication dispensing, and leveraging digital tools. Evidence shows integration reduces overall health system costs by 34–49% compared to managing conditions separately, with additional out-of-pocket savings for clients. Key requirements include: training and supervision of health workers; ensuring medication supply chains; adapting existing electronic medical records; and community engagement. The PRECIS-2 assessment showed most studies were highly pragmatic, demonstrating real-world feasibility.
What are the clinical outcomes and monitoring indicators for integrated care?
For HIV outcomes, integration maintains high viral suppression (pooled estimate 98%, 95% CI: 91–99%) and adherence (89%, 95% CI: 79–94%). For hypertension, blood pressure control improved substantially (OR 1.3–26.5 depending on study design; pre-post studies showed OR 5.7, translating to 395 more per 1000 achieving control). For diabetes, 40% (95% CI: 31–50%) achieved control, though evidence is more limited. For mental health, integration led to large reductions in moderate-to-severe depression (OR 0.5). Monitoring should use existing cohort databases adapted to track outcomes across all conditions, including retention, viral suppression, blood pressure/glucose control, and mental health symptom scores.
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025 edition
- Replaces
- Updated recommendations on service delivery for the treatment and care of people living with HIV (2021); Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection (2016)
- Status
- Current
- Published
- 2025-08-29
- Languages
- English
- Scope
- People living with HIV of all ages requiring chronic care services; integration of diabetes, hypertension and mental health services; adherence support interventions for antiretroviral therapy
- Audience
- Policy-makers, national HIV programme managers, primary health care providers, nurses, community health workers, implementing partners, civil society organizations
- Pages
- 56
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011387-9
- Evidence
- GRADE-rated recommendations based on systematic reviews and meta-analyses of 228 studies (18 on integration of diabetes/hypertension, 46 on mental health integration, 164 on adherence interventions); values and preferences survey; cost-effectiveness analyses
- Next review
- Not specified; updates triggered by scoping exercises of available evidence and country implementation experience
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
WHO guideline on HIV service delivery: updated guidance on the integration of diabetes, hypertension and mental health services, and interventions to support adherence to antiretroviral therapy. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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