Co-designing Integrated HIV, Mental Health and Gender-Based Violence Services: A Scoping Review of Participatory Approaches in Low- and Middle-Income Countries

Imagine a person living with HIV walking into a clinic. They are there for their regular medication, but they are also carrying a heavy, silent burden: perhaps deep depression, or the fear of violence at home. In many parts of the world, these three struggles—managing HIV, treating mental health, and finding safety from violence—are handled by completely different systems. The person might have to travel to a different building for a counselor, fill out new forms that repeat their most private stories, or simply be told to "go see someone else" without a clear path to get there. This separation forces the patient to do the difficult work of connecting the dots themselves, often while navigating stigma and danger. The question researchers ask is whether bringing these services together, and asking the people who need them to help design the solution, can make care safer and more effective.

This idea of "co-design" is central to a new review of research from low- and middle-income countries. Co-design is not just asking people what they think; it is inviting them to sit at the table where decisions are made, helping to shape the rules, the questions asked, and the way support is delivered. The review, led by Moses Tingir and colleagues, looked at how this approach has been used to link HIV care with mental health and violence support. The researchers did not run a new experiment themselves. Instead, they gathered and examined sixteen existing reports published between 2020 and 2025. These reports came from places like Nigeria, South Africa, Uganda, Kenya, China, and Ukraine. The goal was to see what actually happened when service users, community members, and providers worked together to build these connected services, and whether those efforts created a clear, safe path for people to get the help they need.

The researchers found that when people living with HIV and their communities were invited to help design services, the results were often more practical and responsive to real life. In Uganda, for instance, stakeholders gathered in workshops to map out how to treat depression within HIV clinics, ensuring the plan made sense for the staff and the patients. In South Africa, young people helped create a peer-navigation program that linked HIV care with social support, while in China, men recently diagnosed with HIV worked with designers to build a mobile app that addressed their mental health and medication needs. These projects used various methods, from community conversations to digital testing, to figure out what barriers existed. The participants helped decide on the language used in screening questions, how to keep conversations private, and what kind of support felt safe to accept.

However, the review also revealed a significant gap between good ideas and complete solutions. While many projects successfully linked HIV care with either mental health support or violence screening, very few managed to weave all three together into a single, seamless journey. Most programs were like building a bridge between two islands, but the third island remained disconnected. A person might get excellent help for their HIV and their depression, but still have no clear route to safety if they were experiencing violence. The researchers noted that while participation helped shape the content of these services, it did not always guarantee that the services would work perfectly once they were running. The studies often described how a program was designed or how people liked a new app, but they rarely measured whether the referrals actually worked, whether people stayed safe, or if the services continued to exist after the initial funding ended.

The authors suggest that the true value of involving the community lies in making services relevant, but that relevance is only the first step. For a service to truly work, it needs more than just a good design; it needs a functioning system behind it. This means having enough trained staff, clear rules for who does what, and a way to follow up when someone is referred to another provider. Without these practical supports, even the best-designed program can fail to protect a person's privacy or ensure they get the care they need. The review concludes that while co-design is a powerful tool for understanding local needs, it is not a magic fix. The next step for researchers and health leaders is to build services that not only listen to the people they serve but also ensure that the path to help is safe, complete, and available for the long term.