IDEAS for Hope is a nurse-led telehealth counseling intervention for people living with HIV, designed to improve access to mental health services in low-resource settings. The program’s core focus is reducing suicidal ideation through HIV education, advancing treatment adherence, and reducing stigma to renew hope. The intervention is built around a four-pillars framework: living healthy with HIV, becoming free of stigma, meeting basic needs, and seeking social support, which centers on participants’ own reasons for living. A pilot randomized controlled trial conducted with 60 people experiencing recent suicidal thought showed high feasibility and acceptability, as well as strong signals of efficacy for reducing suicidal thoughts, plan, and intent, and improving HIV care engagement. A larger trial is pending, which will aim to assess comparative effectiveness, mechanisms of change, cost-effectiveness. The project is also looking to expand its approach to universal suicide screening and brief intervention to other health care settings in Tanzania, including the emergency department, cancer care, adolescent HIV clinics, and prevention of mother-to-child transmission (PMTCT) clinics.