Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.

青少年是至关重要的一代，他们有潜力为他们自己和他们的国家带来未来的社会和经济成功。超过 90% 的艾滋病毒感染青少年居住在撒哈拉以南非洲地区，他们的心理健康处于贫困、家庭压力、服务差距以及现在与 COVID-19 大流行交织在一起的艾滋病毒流行的背景下。在本系列文章中，我们回顾了针对感染 HIV 和受 HIV 影响的青少年的系统评价、随机试验和队列研究。我们提供了心理健康服务的详细概述，并为未来的方法整理了证据。我们发现感染艾滋病毒的青少年的心理健康负担很重，导致生活质量低下以及坚持抗逆转录病毒治疗的挑战。心理健康服务匮乏，缺少基础设施和熟练的提供者，需要领导。有效干预措施的证据正在出现，包括针对心理健康的具体规定（例如，认知行为疗法、解决问题、正念和育儿计划）和更广泛的规定，以防止导致心理健康不佳的驱动因素（例如，社会保护和暴力预防）。我们提供了无条件政府拨款与改善心理健康之间纵向关联的证据。经济和社会干预措施（称为现金加护理）的组合可以增加心理健康益处。可扩展的交付模式包括任务分担、初级保健整合、巩固家庭以及区分需求水平（从预防到严重疾病护理）的供应金字塔。现在已经到了一个转折点，不能自满。我们的结论是，在建立基础设施和技能获取的同时，存在大量需求、可用框架和不断增长的行动证据基础。