HIV and mental illness are significant global public health concerns in Zimbabwe. A coordinated and comprehensive response, particularly between HIV treatment, care, and support services and mental health care can improve health outcomes among people living with HIV. In collaboration with the U.S. President’s Emergency Plan for AIDS Relief Care and Support and Treatment Technical Working Groups, AIDSTAR-One is implementing a pilot activity that will integrate mental health and harmful substance use screening, counseling, and referral into HIV treatment and care sites in Zimbabwe. This country situational analysis was conducted as a first step in the pilot activity.