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Fig 1.

Conceptual framework for fidelity of implementation of the malaria test-and-treat strategy.

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Fig 2.

Map of Amhara Regions shows the study woredas.

The map was produced by the authors using QGIS software and publicly available administrative boundary layers from the Ethiopian Central Statistical Agency and Natural Earth.

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Table 1.

CFIR Construct Mapping for Qualitative Coding.

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Table 2.

Characteristics of Healthcare Facilities and Healthcare Providers, Amhara Region 2025 (N = 53).

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Table 3.

Association Between Facility Type and Malaria Test Method, Amhara Region, 2025.

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Fig 3.

Healthcare Providers’ Knowledge of Malaria Treatments, Amhara Region, 2025.

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Fig 4.

Implementation of facility strategies, Amhara Region, 2025.

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Fig 5.

Fidelity Score by Facility Type (n = 53), Amhara Region.2025. Box plots show median (line), IQR (box), and range (whiskers). Mann-Whitney U test: p = 0.041.

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Table 4.

Bivariate analysis of implementation fidelity scores.

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Table 5.

Multivariable linear regression (OLS): implementation moderators associated with composite fidelity score (0–100) (N = 53).

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Table 6.

Multivariable linear regression (OLS): facility characteristics, respondent characteristics, and moderators associated with composite fidelity score (0–100) (N = 53).

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Fig 6.

Sensitivity analysis of fidelity scoring methods, comparison of mean fidelity using alternative scoring approaches.

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Table 7.

Demographics of In-Depth Interview Participants by Facility Type (N = 32), Amhara Region, 2025.

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Table 8.

Joint display of fidelity domains/moderators: quantitative results and qualitative explanations.

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Fig 7.

Joint display of quantitative fidelity scores and qualitative CFIR barriers, matrix visualizing facility-level fidelity scores alongside identified implementation barriers.

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