Mental Health Support Should Be Central to HIV Care in Rwanda: A Call for Action

Rwanda has made substantial progress in HIV diagnosis, treatment, and viral suppression. However, these achievements do not necessarily reflect the mental health and psychosocial well-being of people living with HIV (PLHIV). Evidence from Rwanda indicates that mental health disorders remain underrecognized and undertreated, even among individuals achieving favorable HIV treatment outcomes. Although national HIV guidelines recommend routine mental health screening and referral, there is limited evidence on how consistently these recommendations are implemented across HIV services. This Perspective argues that the priority is not simply to advocate for mental health integration, but to make existing recommendations work in everyday clinical practice. Drawing on Rwanda's experience with decentralized healthcare, task sharing, and supportive supervision, we propose a practical approach that connects mental health screening with appropriate assessment, first-line psychosocial support, referral, and follow-up. Key priorities include strengthening frontline provider competencies, establishing clear responsibilities across levels of care, involving PLHIV in service design, and monitoring whether patients receive appropriate support. These actions should be introduced progressively and evaluated for feasibility, acceptability, continuity of care, and sustainability. Strengthening mental health integration does not require specialist services in every ART clinic; it requires a coordinated system in which mental health needs are recognized, and patients can access appropriate care. Moving from policy recommendations to measurable improvements in service delivery is essential to advancing person-centered HIV care in Rwanda.