Chlamydia trachomatis (CT) infection remains an important public-health and reproductive-health challenge in China. Guangdong Province launched the province-led “3331 Strategy” to integrate CT prevention with reproductive health, maternal and child health, and other sexually transmitted infection services; strengthen surveillance, testing, diagnosis, treatment, and case-management systems; expand testing among priority populations; and standardize the pathway from health promotion and screening to treatment, reporting, and follow-up. This study examined how the strategy was implemented across municipal health systems with different levels of early implementation performance. We conducted a post-implementation interpretive qualitative evaluation using a comparative case approach guided by the 2022 updated Consolidated Framework for Implementation Research (CFIR). All five existing municipal pilot implementation units were included as information-rich cases. Semi-structured telephone interviews were conducted with 60 administrative, public-health, programme-management, clinical, laboratory, nursing, and frontline service-delivery stakeholders. Two analytic streams were developed independently: a CFIR determinant-assessment stream based on coding, unit-construct evidence pools, case memos, and consensus ratings; and an implementation-performance stream based on project indicators, implementation records, programme documents, field-assessment notes, and expert-informed comparison. The streams were brought together only for cross-case interpretation. The cross-case joint display identified four explanatory patterns. First, Innovation Complexity interacted with local absorptive capacity: prior CT screening experience, workflow familiarity, laboratory capacity, and coordination routines helped the higher-implementation unit manage the multistep pathway, whereas lower-implementation units experienced target-population classification, questionnaire completion, specimen labelling and transfer, result feedback, and follow-up as cumulative burdens. Second, privacy-sensitive engagement was constrained by STI-related stigma, concern about disclosure, sensitive questionnaire items, and low public awareness. Third, leadership support, perceived need, and frontline commitment created a mandate to implement but were insufficient without practical workflow tools, site-specific training, material resources, and accountable coordination. Fourth, pandemic-related disruption and other contextual constraints were buffered or amplified by local adaptation, team organization, resource fit, and execution capacity. Province-led CT control requires both a clearly specified provincial core and implementation support that enables local systems to absorb operational demands. Refinement of the 3331 Strategy should simplify patient-facing procedures, strengthen confidential and non-stigmatizing communication, expand site-specific training, clarify laboratory and inter-institutional responsibilities, and permit feasible local adaptation. Separating determinant assessment from performance classification, and then integrating them through a cross-case joint display, provides a transparent basis for interpretation and programme action. Not applicable.
The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) is widely used to evaluate how evidence-based practices are implemented and adapted within healthcare organisations. How its domains are measured in inpatient medical and surgical care is less well described. We asked which metrics have been used to measure each RE-AIM domain in inpatient care, and whether metric choice differs by intervention type or setting, so as to identify metrics transferable to spine and neurosurgical practice. Curating this evidence base can help inform future implementation strategies. RE-AIM publications were identified via the curated list on re-aim.org, which links to a PubMed search of publications citing or applying RE-AIM since its 1999 description, run on 20 September 2025 and returning 1,943 records. Eligible studies explicitly applied RE-AIM to the design or evaluation of an intervention delivered to admitted patients, or to the staff caring for them, in an inpatient or emergency setting, in English; editorials, protocols without results, and reports citing but not applying RE-AIM were excluded. Two reviewers screened independently in Rayyan and extracted data into a proforma. Each RE-AIM domain was coded against a pre-specified definition, unit of analysis and decision rules, and findings synthesised narratively. Fifty-five studies were included, most from high-income countries (51/55, 92.7
Women living with HIV (WLWH) experience earlier and more severe menopausal symptoms, yet access to evidence-based menopausal care remains limited. In sub-Saharan Africa, where HIV is most prevalent, implementation gaps persist in integrating menopausal care into HIV services. We explored perspectives of WLWH and HIV clinicians in Uganda to identify multilevel barriers and facilitators to integrating menopausal care into routine HIV services. We conducted a qualitative study between August and December 2025 at HIV clinics in Mbarara and Masaka Regional Referral Hospitals, Uganda. Using purposive sampling, we interviewed 29 participants, including 19 WLWH aged 45–60 years (6 premenopausal, 6 perimenopausal, and 7 postmenopausal) and 10 clinicians representing junior (n = 2), mid-level (n = 5), and senior (n = 3) cadres. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using a theory-informed thematic approach guided by the Theoretical Domains Framework (TDF). Data were coded deductively to TDF domains in Dedoose until no new themes emerged across successive interviews. Key barriers to integration included clinicians’ limited knowledge and skills in menopausal care, which contributed to symptom misattribution, as well as low menopausal health literacy and stigma among WLWH that impeded care-seeking. Additional barriers included professional role ambiguity driven by prioritisation of HIV performance targets, and structural constraints such as absent clinical guidelines and medication shortages. Facilitators included trusted client–provider relationships that supported holistic care, community peer- and faith-based networks that normalised menopausal experiences, and stakeholder consensus on the need for integrated menopausal care into routine HIV services for optimal long-term HIV care outcomes. Our study found that menopause is invisible, misattributed, and structurally neglected within HIV services. Knowledge gaps, role ambiguity, resource scarcity, and symptom misattribution hinder integration of menopausal care into HIV services. Leveraging trusted client-provider relationships and peer networks to co-create clinical guidelines and context-appropriate implementation strategies could achieve holistic health for aging WLWH in sub-Saharan Africa.
Patients with acute heart failure (AHF) discharged directly from emergency departments (EDs) are at high risk for 30-day revisits, readmissions, and mortality. Most transitional care interventions have focused on inpatient settings, thereby excluding this vulnerable population. Our team developed a self-care coaching intervention called Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) to address care transitions for patients with AHF discharged from EDs, aiming to improve patient self-management and clinical outcomes. We describe the implementation outcomes of a large hybrid type 2 study conducted across six EDs in two geographically diverse healthcare systems, guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Care Transitions Intervention frameworks. We employed a multifaceted implementation strategy that included a best practice alert in the electronic health record, identification of local champions, educational meetings, and implementation of audit and feedback mechanisms. Data was collected through ED staff surveys, electronic health records, and monthly tracking sheets to assess implementation outcomes of reach, adoption, implementation, and maintenance. Clinical effectiveness is reported elsewhere. The study reached 37
Sustainment and sustainability of implemented complex evidence-based interventions in mental health settings remain an under-researched area of implementation science. Understanding what contributes to the ongoing use of evidence-based practices (EBPs) can inform all stages of implementation and help ensure effective treatment for patients. This study evaluated the sustainment of evidence-based practice for post-traumatic stress disorder in Norwegian mental healthcare 1, 2 or 3 years after the completion of a one-year implementation support provided to clinics between 2018 and 2022. The implementation support was based on the Leadership and Organizational Change for Implementation strategy (LOCI). We measured implementation climate immediately after the implementation support period ended, and sustainment and organizational capacity for sustainability 1, 2 or 3 years after. We examined the relationship between organizational capacity for sustainability and implementation climate in relation to sustainment using mixed-effect modelling. Eleven out of 43 clinics (25.6
