Assessing retention of pandemic capacities from COVID-19 in humanitarian settings: A cross-sectional retrospective study of health workers in Honduras, Syria, and South Sudan

PLOS Global Public Health · 2026-04-20

The global health security landscape remains critically vulnerable to emerging pandemic threats. Humanitarian settings face particularly acute challenges in health workforce preparedness and response capabilities. Humanitarian settings have traditionally been left out of global health security and other health system strengthening investments. There is also a significant gap in the literature around building sustained health worker pandemic capacities in these challenging contexts. This novel study measured the retention or 'shelf-life' of perceived COVID-19 training benefits for health workers around knowledge, skills, and confidence to face future infectious disease threats. The Dynamic Sustainability Framework was used for conceptual framing. The study spanned three distinct humanitarian settings: Honduras, Syria, and South Sudan. Employing a cross-sectional, retrospective self-assessment design, 129 primary healthcare and community level health workers were surveyed in March-April 2024. Participants self-reported pandemic capacities on five-point Likert ratings across three time points - retrospective recall for pre- and post-training, and for present status, which was on average three years after training. Results demonstrated substantial increases post-training in self-reported knowledge (p < 0.001), skills (p < 0.001), and confidence (p < 0.001), and sustained or improved capacities at present (knowledge (p < 0.01), skills (p < 0.01), and confidence (p < 0.001)). Despite low access to ongoing training, resources, and support, 84.3% of health workers reported feeling prepared to face emergent disease risks (COVID-19 or other). The results call for further exploration of the individual, training-related, facility, and contextual factors affecting the capacity retention. Due to study design limitations, these results cannot be attributed to the trainings or generalized to all health workers in these countries. Still, this research contributes critical insights into the potential sustained benefits of frontline health workforce pandemic capacity building in humanitarian settings. Since capacities were retained despite limited ongoing training and support, targeted, sustained investments become crucial to preserve and enhance health security in the most fragile health systems.

Designing integrated care models for mental health and tuberculosis in Pune, India: A formative qualitative study of patient, caregiver and provider perspectives

Cambridge Prisms Global Mental Health · 2026-01-01

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

Towards a decolonising implementation science: principles from Indigenous leadership

The Lancet Global Health · 2026-01-07 · 1 citations

Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.

Commonality and co-occurrence of discrete strategies within implementation strategy bundles: findings from the Living Database of HIV Implementation Science systematic review, 2014–2021

Implementation Science Communications · 2026-03-13

BACKGROUND: HIV services and innovations are delivered through implementation strategy bundles that are often complex, comprising numerous discrete strategies. Systematically characterizing the use patterns of discrete strategies may inform strategy prioritization and selection to optimize service delivery. We used the Living Database of HIV Implementation Science (LIVE) to describe the commonality and co-occurrence of discrete strategies within multi-component strategy bundles in published HIV implementation studies from low- and middle-income countries. METHODS: The LIVE systematic review identified studies from PubMed, Embase, and CINAHL, and included HIV implementation studies that reported ≥ 1 HIV care cascade outcome, were conducted in low- and middle-income countries, and were published between January 1, 2014, and August 27, 2021. Discrete strategies were inductively specified (e.g., actor, action, action target) and classified into 5 categories consolidated from 2 strategy taxonomies, Effective Practice and Organisation of Care and Expert Recommendations for Implementing Change. Network analysis was conducted to describe the co-occurrence of discrete strategies within study arm strategy bundles. RESULTS: A total of 4,253 discrete implementation strategies were identified from 868 study arms across 485 individual studies, with a median of four reported strategies per study arm (range: 1-21). The most common strategies used were 'providing education on a health innovation, service, or behavior' (60%; 520/868) and 'training to learn a new skill' (30%; 260/868) under the 'Capacity Building and Support' category. These were also the most commonly co-occurring strategies within strategy bundles (degree centrality: 4,894 and 3,488, respectively) and were most often present to allow other strategies to co-occur in bundles (betweenness centrality: 3,526.3 and 1,647.0, respectively). Several other 'Capacity Building and Support' or 'Health Service Delivery' categories were common and central. Strategies related to 'Financial Arrangement,' 'Governance,' and 'Implementation Process' were infrequently reported and/or underutilized. CONCLUSIONS: Capacity building approaches and changes to health service delivery are common in published HIV implementation strategy bundles. Future implementation studies should evaluate bundles of a more diverse range of strategies that target barriers at organization and health system levels.

Testing the effectiveness of Family Spirit Strengths (FSS) – a culturally informed intervention designed to prevent mental health and substance misuse for indigenous families through home visiting

BMC Public Health · 2026-02-26

Families represent the foundation of health for many Indigenous communities. Yet, Indigenous women, particularly women of the age who are starting families, face profound challenges related to mental health and substance use. These challenges are rooted in historical trauma, ongoing discrimination, systemic racism, and chronic underfunding of mental health and substance use services, and result in significant gaps in access to care. Family-based home visiting has the potential to address multiple types of mental health and substance use concerns in a way that is more accessible and culturally acceptable. However, to date, there are no empirically supported family-based home visiting interventions designed to specifically to address these concerns in Indigenous communities. Family Spirit Strengths is a culturally tailored intervention developed to help fill this gap. This study is a Hybrid Type I Effectiveness-Implementation randomized controlled trial with the primary goal is to test the effectiveness of Family Spirit Strengths (FSS) at reducing poor mental health days, symptoms of depression, anxiety, and substance use, among N = 188 primary caregivers across three diverse Tribal settings and contexts. Participants will be randomized 1:1 to receive FSS or a beneficial control, an evidence-based nutritional support program. FSS is a transdiagnostic secondary-prevention intervention that was adapted from the evidence-based Common Elements Treatment Approach. The FSS intervention consists of 4–16 lessons (average 6–8 lessons), tailored to participant needs, delivered weekly or bi-weekly by a trained home visitor. Primary outcomes will be measured 6–9 months post-enrollment. We will also seek to characterize heterogeneity and mechanisms of FSS effects by using mixed methods and exploring moderators and mediators of impact. We will also estimate FSS costs, cost-effectiveness, and budget impact. Serious mental health and substance use issues have long been challenges home visitors encounter with few tools to help, beyond screening and referral to clinical services, which are often hard to access if available at all. This has been particularly true when working with Indigenous families due to the profound mental health and substance use inequities they face. This trial will inform the evidence base for transdiagnostic interventions delivered through early childhood home visiting. NCT05836090; registered April 18, 2023.

“Measuring the gap”: advances and practical considerations in assessment of adoption, penetration, and sustainment of HIV prevention services

Current Opinion in HIV and AIDS · 2025-08-26 · 1 citations

PURPOSE OF REVIEW: Prior reviews have documented lack of consistency around implementation outcome measurement and gaps in assessing adoption, penetration or reach, and sustainment in HIV research. Our review sought to summarize approaches to measuring adoption, penetration, and sustainment in the HIV research literature, with a focus on the preexposure prophylaxis (PrEP) field which is ripe for exploration as long-acting PrEP formulations become available and oral PrEP programs become increasingly sustained. RECENT FINDINGS: Our literature search of adoption, penetration, and sustainment measurement in HIV research identified 250 manuscripts. We developed a conceptual heuristic of latent and manifest measures for HIV implementation research. Few PrEP studies measured adoption according to our heuristic and latent adoption measurements were often conflated with acceptability, while manifest measurements were conflated with penetration. Most PrEP studies measuring penetration focused on the client level, with fewer measuring penetration among organizations or providers. Sustainment measurement across studies was diverse and included mixed methods assessment at organization, provider, and client levels. SUMMARY: Heterogeneity persists in operationalizing adoption, penetration, and sustainment. Future work is needed to develop and validate pragmatic and robust measures of these constructs that can be used in evolving HIV implementation contexts.

Recommendation: Designing integrated care models for mental health and tuberculosis in Pune, India: A formative qualitative study of patient, caregiver and provider perspectives — R1/PR7

2025-10-25

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

Review: Designing integrated care models for mental health and tuberculosis in Pune, India: A formative qualitative study of patient, caregiver and provider perspectives — R0/PR3

2025-08-05

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

Recommendation: Designing integrated care models for mental health and tuberculosis in Pune, India: A formative qualitative study of patient, caregiver and provider perspectives — R0/PR4

2025-08-05

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

Building the Road to End the HIV Epidemic Through Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation REsearch (CHESHIRE): Reflections and Directions: Erratum

JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-04-18