Multi-Stakeholder Governance and HIV Service Effectiveness Across Global Contexts: A Scoping Review of Governance Mechanisms and Outcomes

Background: Human Immunodeficiency Virus (HIV) service delivery involves governments, healthcare providers, non-governmental organizations, community organizations, peer actors, and other stakeholders, but the contribution of multi-stakeholder governance remains difficult to interpret because stakeholder participation, service-delivery interventions, and governance arrangements are often reported together. This scoping review mapped how governance functions, stakeholder roles, contextual conditions, and HIV service outcomes are connected across diverse settings. Methods: This scoping review followed PRISMA-ScR guidance and used the Population, Concept, Context (PCC) framework within an Arksey and O’Malley approach. Five electronic information sources PubMed/MEDLINE, DOAJ, Scopus, ScienceDirect, and SpringerLink were searched for English-language publications from 1 January 2021 to 6 March 2026. Eligible studies documented a governance-relevant function, governance-linked stakeholder process, or governance-responsive service interface within HIV services and reported, assessed, or planned a service or implementation outcome. Three reviewers screened and charted the evidence, with disagreements resolved by consensus. Evidence was analytically separated into completed empirical studies and protocols, and outcomes were classified as observed, perceived/implementation, or planned. Results: Of 867 records identified, 68 duplicates were removed, 799 records underwent title and abstract screening, 91 full texts were assessed, and 15 studies were included. Eleven were completed empirical studies and four were protocols. The synthesis distinguished three governance mechanisms (1) institutional/intersectoral coordination, (2) participatory co-design and shared prioritization, and (3) community-mediated governance and service intermediation and two governance-responsive service interfaces: differentiated service delivery (DSD) and digital health. Observed service or clinical outcomes included HIV testing, ART initiation, and service engagement, whereas provider capacity, feasibility, acceptability, and coordination were treated as implementation or perceived outcomes. Protocols contributed planned intervention and evaluation pathways only. Conclusion: Evidence of a causal link between multi-stakeholder governance and HIV service effectiveness remains limited. Its impact depends on contextual factors, while DSD and digital health function as delivery interfaces. Future research should assess governance mechanisms and outcomes longitudinally.