Integrate. Invest. Impact. Why HIV, TB, and Other Health Needs Must Come Together

The good news is that mental health is finally gaining the attention it deserves, especially as we better understand the profound emotional and social impacts of HIV and TB. Yet, true integration means even more: Integration challenges us all to reimagine what real impact looks like. It’s no longer enough simply to count infections averted or treatments delivered. We must also ask: Are people receiving care that is comprehensive, respectful, and genuinely person-centred? This requires two things: sustained investment and a commitment to embedding integrated services at every level of the health system, especially in Primary Health Care (PHC).

What’s changing? Key findings from a review

A new joint review from UNAIDS and United for Global Mental Health, funded by Grand Challenges Canada, looked at how 103 countries are integrating priority comorbidities, including noncommunicable diseases (NCDs), cervical and other cancers, and mental health and substance use conditions, into their HIV and TB programmes in Grant Cycle 7 (GC7). The findings show both promise and strain.

Here’s what stood out:

• Countries requested US$554.7M for comorbidities, showing strong demand for more integrated, people-centred care.
• 89% of these requests remains unfunded, listed in the Global Fund’s “priority above allocation request” (PAAR).  This means these needs are recognised as important but fall outside the current country allocation and could be funded if additional resources become available.
• Most requests focused on NCDs (46.5%), followed by substance use conditions (21.6%), cancers (18%), and mental health conditions (13.9%).
• Only 11% of requests (US$61.7M) were funded from existing allocations.
• Mental health and substance use conditions received nearly 70% of the allocated funding, indicating that these areas were prioritised within the resources that were available.

Implementation trends and gaps

We also saw that many countries are implementing integrated, people-centred care through co-located or “one-stop” services, but crucial linkages to PHC are often missing.  Likewise, monitoring and accountability are weak, with no metrics for NCDs, mental health, and cancers, and substance use indicators focusing mainly on reach rather than outcomes. The review also indicated that technical assistance is severely underfunded, receiving just 0.2% of requested resources (US$11.3M), despite countries articulating clear needs for support to implement and sustain these programmes.

The path forward: PHC as the foundation 

If integration is the goal, robust PHC is the means to get there. PHC is where most people first seek care, and it’s where long-term conditions are best managed. Yet in many countries, PHC remains underfunded and fragmented. Trying to integrate multiple services into HIV and TB programmes alone risks overwhelming them.  A more sustainable approach is to embed HIV, TB, and comorbidity care within PHC, while also strengthening PHC itself.

Integrate. Invest. Impact.

Here’s the bottom line: Countries are stepping up to confront comorbidities head-on, but in this time of financial austerity, financing and support must catch up. Our collective progress in addressing HIV, TB, and their comorbidities depends on embedding these services within a strong PHC, backed by sustained investment and strategic technical support.

By prioritising integration, committing resources, and measuring real impact, we can ensure that health systems meet the full spectrum of individuals’ and communities’ needs, delivering care that is truly person-centred. As Gavin Reid from The Global Fund said,

“The GC7 review reminds us that ‘mental health conditions can delay access to and decrease the effectiveness of HIV prevention, testing and care.’ As countries prepare for GC8, prioritising mental health is one of the most cost‑effective ways to strengthen health outcomes.”

The full review may be accessed here.