Sustainability of infectious disease elimination: a scoping review on integrating treatment and surveillance within health systems.

backgroundGlobal infectious disease elimination programmes have historically relied on vertical, donor-driven approaches. However, amid reduced global funding and increased emphasis on country ownership and sustainability, interest in infectious disease-specific activities integrated into routine health systems is growing. Yet evidence on how integration has been implemented remains fragmented. This scoping review takes a multi-disease approach to assess the extent and nature of evidence on the integration of infectious disease elimination and eradication programmes into routine health systems, with a focus on treatment and surveillance functions. The review was conducted following Joanna Briggs Institute guidelines and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework.

objectivesThe objectives were to map and synthesise integration approaches, identify context-specific facilitators and barriers and review research methods used. ELIGIBILITY CRITERIA: Eligible studies were peer-reviewed, examined efforts to integrate treatment and/or surveillance functions for diseases with elimination or eradication goals into health systems, and reported at least one outcome. Articles were published between 2010 and 2024 on studies conducted in low- and middle-income countries. SOURCES OF EVIDENCE: MEDLINE, Embase, Global Health and Web of Science were searched. CHARTING

methodsData were charted using a standardised extraction form that captured study characteristics, integration activities, health system level, facilitators and barriers, outcomes measured and research methods. Extracted data were synthesised descriptively using quantitative summaries and qualitative thematic analysis to identify patterns across studies.

resultsThe search yielded 5938 records, of which 45 studies met inclusion criteria. Studies spanned 23 countries and 20 diseases. Integration commonly involved task shifting to primary healthcare providers, expanded roles for community health workers and new responsibilities for district and national health authorities. Key facilitators included adopting a health systems strengthening approach with strong government ownership. Barriers included supply chain challenges, unclear roles and weak partner coordination. Evidence on costs was limited, though some studies described initial donor-funded start-up with longer-term absorption by governments. The study designs reflected varied disciplinary perspectives.

conclusionsThis review identifies substantial gaps in the evidence base on implementing integration, particularly regarding surveillance and the economic implications of integration. However, common principles emerged across diverse settings and diseases that can inform future integration efforts. Across the included studies, integration was consistently described as a health system change process, with implications for research, policy and practice related to early planning, stronger country leadership and donor coordination, broader engagement across the health system and health system strengthening.