Mapping implementation challenges and solutions in a pregnancy cohort study on emerging infections in Honduras: A pathfinder study

<ns3:p> Background In low- and middle-income countries (LMICs), persistent gaps hinder research studies and tend to worsen during public health emergencies. Pathfinder is a methodological framework used for process-mapping, and documenting process stages, barriers, and solutions. ZIPH-Track applied this framework to the ZIPH (Zika in Pregnancy in Honduras) study, a prospective pregnancy cohort initiated in 2016, an example of a North-South-South collaboration. Methods ZIPH-Track, conducted from June 2024 to May 2025, used mixed-methods with a convergent design. An online questionnaire was administered to the implementation team (n=15) to record, by stage, activities, perceived difficulty, resources, tools, roles, and funding. Semi-structured interviews were conducted with key personnel (n=7), audio-recorded, transcribed, and analyzed using open, axial, and selective coding. Integrating both sources reconstructed the process map to identify operational components, barriers, facilitators, and solutions. Results Mapping included from preparation through dissemination stages and incorporated a pre-2016 stage identified as the operational basis for timely mobilization during the Zika epidemic in Honduras. Barriers were clustered in three domains: structural ( <ns3:italic>v.g</ns3:italic> ., turnover of authorities), technical/operational ( <ns3:italic>v.g</ns3:italic> ., rapid start-up with limited diagnostic capacity) and contextual ( <ns3:italic>v.g</ns3:italic> ., support during COVID-19 pandemic). Solutions included early technical leadership and staged planning, flexible cohort redesign, continuous training and adoption of validated tools, secondary use of samples with ethical approval, and remote follow-up with periodic procedural review. Pre-existing facilitators, including basic infrastructure, accumulated experience, and participant trust, supported continuity and enabled the transition to a more adaptable platform including Chagas disease. Conclusion Using pathfinder framework enabled a structured reconstruction of the conditions that made the sustained implementation of a complex prospective cohort study, result of a triangular collaboration, possible amid health emergencies and operational constraints. The findings offer practical input for teams in LMICs and promote practices aligned with equity, sustainability, and local relevance in maternal and child health. </ns3:p>