There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population.The authors summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. It is emphasized key considerations that can guide integrated care in SSA and point to possible interventions for implementation.