The burden of mental health problems among elderly persons living with HIV in countries across sub-Saharan Africa: systematic review and meta-analysis protocol

Background: The burden of HIV (human immunodeficiency virus) infection among the elderly has seen an increasing trend over the years. With improved treatment outcomes for HIV, it is expected that persons with the infection will experience longer life expectancy. The elderly are a very vulnerable group and prone to numerous health complications including cognitive decline associated with ageing. HIV infection among this group presents increased complications to their health, particularly their mental health. It is, therefore, imperative to investigate the burden of mental health problems among these vulnerable elderly persons living with HIV. Methods: All relevant databases, grey literature, and non-database sources will be searched. The databases to be searched include PubMed, LILACS, CINAHL, SCOPUS, and PsycINFO, from inception to March 31, 2025, with no language restrictions. We will also search African Index Medicus, HINARI, African Journals Online, and IMSEAR. Reference lists of articles will be reviewed, and experts will be contacted for additional studies missed by our searches. Study selection, data extraction, and risk-of-bias assessment will be conducted independently by at least two reviewers after a calibration exercise. Any discrepancies will be resolved through discussion. Binary outcomes, such as the prevalence and incidence of mental health problems, will be assessed using pooled proportions, odds ratio (OR), or risk ratio (RR), and continuous outcomes will be measured as mean differences (MD) with standard deviation; all estimates will be presented with their 95% confidence intervals (CIs). Heterogeneity will be assessed graphically by checking for overlapping CIs and statistically using the I² statistic. Subgroup analyses will be performed to address heterogeneity. Random-effects model meta-analysis will be conducted to obtain pooled estimates. The overall level of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Discussion: This systematic review aims to investigate the burden of mental health problems among elderly people living with HIV (EPLHIV). This is crucial due to the unique challenges posed by both ageing and HIV. Mental health issues in this population, such as depression and anxiety, can lead to poor adherence to antiretroviral therapy (ART), negatively impacting health outcomes and increasing the risk of AIDS progression. Despite existing research, significant gaps remain, particularly regarding less commonly studied mental health conditions like schizophrenia and bipolar disorder in these vulnerable groups. In sub-Saharan Africa (SSA), the burden and determinants of these conditions among EPLHIV are largely unknown. Addressing these gaps through targeted research can inform the development of integrated care models that improve the quality of life and overall well-being of this vulnerable group, guiding public health policies and enhancing mental health services. Systematic review registration: PROSPERO CRD42024574793.