This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa (SSA), evaluate the strategies and interventions in SSA countries used to retain their nurses, and identify the key challenges impeding nurse retention. A systematic review and meta-analysis were conducted. An electronic search was performed in August 2024 across multiple databases, including PubMed, Ovid Medline, Embase, CINAHL, Scopus, and grey literature sources. The studies were screened using Covidence, and quality assessments were conducted using the Mixed Methods Appraisal Tool. A total of 31 articles were included in the review. Meta-analysis revealed that the pooled nurses’ retention rate in SSA was 53 % (95 %CI: 38 %–67 %; I² = 97 %), while the pooled intention to stay (ITS) rate at work was 57 % (95 %CI: 43 %–71 %; I² = 99 %). Subgroup analysis by region showed that the ITS rate was highest in East Africa (65 %), followed by West Africa (63 %), and lowest in Southern Africa (35 %). Effective retention strategies included financial and non-financial incentives, increased production and training of nurses, steering students to shortage specialties, adequate rural housing, facility level improvements, availability of career and professional progression opportunities, nurses’ recognition and involvement, employment terms, transparency and predictable management of human resources, supportive work environments, leadership, religious factors, and stakeholders’ collaborations. Key challenges to nurses’ retention include inadequate healthcare funding, governance issues, poor remuneration and working conditions, political interference, high unemployment rates, ineffective mobility management, unregulated international migration, and active recruitment by wealthier nations. Nurse retention in SSA remains critically low. Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.

We investigated associations between community-based care and microfinance with psychological distress among adults with HIV in Kenya. Using Harambee cluster-randomized trial data, we compared 18-month psychological distress symptom levels between microfinance participants randomized to integrated community-based care (MF+ICB) or usual facility-based care (MF+UC), and non-randomized matched facility-care patients (UC). Psychological distress symptoms were measured by Patient Health Questionnaire−4, Patient Health Questionnaire−2 (depression), and Generalized Anxiety Disorder-2 (anxiety). For within-group change analysis, we used linear mixed models with a random intercept; for between-arm comparisons, we used Poisson regression with cluster-robust errors for risk ratios. Participants in all arms reported a significant reduction in psychological distress symptoms, except for anxiety in UC. MF+ICB participants had significantly lower anxiety risk than MF+UC (RR=0.57, 95% CI: 0.36–0.90, p=0.016). Both MF arms showed better outcomes than UC. Community-based HIV care within microfinance groups may offer added anxiety-reduction benefits, though findings involving UC are exploratory.

There is strong evidence of the correlation between economic hardship and poor mental health outcomes among people living with HIV (PLHIV). However, the causal efficacy and mechanisms of specific economic interventions through which they contribute to mental health improvement among PLHIV remain fragmented and inconsistent. This systematic review aims to collate and synthesize existing evidence on the effect of economic empowerment interventions on mental health symptoms among PLHIV in low- and middle-income countries (LMICs). We conducted a comprehensive literature review that adhered to the PRISMA guidelines for methodological rigor and transparency. Comprehensive searches were conducted in PubMed, Web of Science, Embase, CINAHL, Scopus, and MEDLINE. We conducted a narrative synthesis of 11 studies: two cohorts, two qualitative, one intervention (non-randomized), and six randomized clinical trials. We registered this review with PROSPERO (CRD420251152471). The process theory served as an analytical framework. Evidence suggests that multi-component economic empowerment interventions (e.g., combined savings, skills training, and psychological support) may be associated with improved mental health among PLHIV in LMICs. Qualitative evidence from other studies suggested that reduced financial stress and strengthened psychological resources may contribute to improved mental health. The effectiveness of the intervention depends not only on simple cash transfers but also on a theoretically sound integrated approach. Interventions were more effective among lower-income groups. Integration of multi-component economic and psychosocial interventions into standard HIV care could improve mental health outcomes among PLHIV in LMICs and is hereby recommended by this study.