To evaluate the availability of mental health services and resources across a stratified multistage sample of care and treatment clinics (CTCs) delivering HIV care from eight geographical zones of Tanzania.

Cross-sectional facility-based baseline survey.

81 CTCs representing national geographical zones and service delivery tiers.

Health facility in-charges or service providers with knowledge of HIV/non-communicable disease (NCD) services (Tier 1: n=11; Tier 2: n=13; Tier 3: n=9; Tier 4: n=48).

Availability of (1) trained mental health professionals, (2) screening/assessment tools for mental health and (3) educational materials.

Mental health services were unevenly distributed across facility tiers. Over half of Tier 1 facilities reported having trained mental health professionals (6/11; 54.5%) and screening tools (6/11; 54.5%), compared with only 35.4% (17/48) and 2.1% (1/48), respectively, in Tier 4 facilities. No Tier 2 or Tier 3 facilities reported availability of trained staff or screening tools. Educational materials were present in only 18.2% (2/11) of Tier 1 facilities and 8.3% (4/48) of Tier 4 facilities. Overall, more than two-thirds of facilities lacked any mental health resource assessed.

Mental health services remain limited across all facility levels, with nearly complete absence at lower-tier facilities. Urgent investment is required to integrate mental health into HIV and NCD care, especially at primary care settings.