This study employs the fuzzy-set qualitative comparative analysis (fsQCA) method to analyze 27 representative cases of treatment-prevention integration across China, aiming to identify generalized implementation pathways for achieving such integration. The results indicate that none of the six antecedent conditions, including system integration, organizational management, service delivery, staffing support, information construction, and performance incentives, constitutes a necessary condition for achieving treatment-prevention integration. However, configuration analysis identifies three distinct pathways leading to a high level of integration, namely the “administration-led” pathway, the “staff-supported” pathway, and the “digitally-driven” pathway. The study demonstrates that effective advancement of treatment-prevention integration within compact county-level healthcare community relies on configuration matching and coordinated interaction among multiple conditions. Therefore, regions should select implementation pathways tailored to their local resource endowments and enhance the overall effectiveness of integration by strengthening coordination among key elements.