<p>Although the relationship between HIV and mental health is well-established, limited research has focused on the available interventions for adults living with HIV (ALWH), particularly those in sub-Saharan Africa (SSA) where the epidemic is most severe. In this paper, we systematically review the literature on mental health interventions for this population during the modern treatment era, aiming to situate them along the HIV care continuum and provide a concise examination of their efficacy. A comprehensive search across PubMed, CINAHL, EMBASE, and PsycINFO identified 13 studies that met the inclusion criteria, and risk of bias was assessed using the Quality Assessment of Controlled Intervention Studies tool. Depressive symptoms were the primary intervention target across all studies, followed by symptoms of anxiety (<i>n</i> = 7). Interventions employed psychosocial, pharmacological, and behavioral mechanisms, including counseling, problem-solving therapy, and antidepressants. Qualitative synthesis showed that interventions were primarily delivered during the “Receiving HIV Care” step of the HIV care continuum, with limited evidence at the HIV diagnosis, linkage to care, and viral suppression stages. While interventions were generally associated with improved mental health outcomes, statistically significant effects were not consistently observed. Evidence on HIV-related outcomes was also limited to eight studies and yielded mixed results. These findings underscore the need to expand mental health services and implementation research for ALWH. Addressing gaps across the HIV care continuum, including broader mental health outcomes and culturally adapted assessment tools, may strengthen integrated HIV and mental health programming in SSA and support efforts to end the HIV epidemic.</p><p>The trial was preregistered at Prospero Registration Number: CRD42024577597</p>