Marr Chung, Amanda, Murungu, Joseph, Case, Peter, Chitapi, Precious, Chikodzore, Rudo, Gosling, Jonathan, Sinokuthemba, Xaba, Ncube, Getrude, Mugurung, Owen, Kunaka, Patience, Prata, Ndola, Gosling, Roly Daniel, M. Bertozzi, Stefano M., and Auerswald, Colette (2025) Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention program into routine health services in Zimbabwe: a qualitative study. BMJ Global Health, 10 (8). e018732. (In Press)

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Abstract

Introduction: The transition of voluntary medical male circumcision (VMMC), an HIV prevention service, in Zimbabwe from a donor-funded to a government-owned programme involves the collective efforts and alignment of national and subnational government leaders, managers, healthcare providers, village health workers, community members, donors and implementing partners. We sought to understand stakeholders’ perspectives on barriers, facilitators and recommendations as a vertical HIV prevention programme transitioned to an integrated, government-led model.

Methods: We conducted 54 semistructured stakeholder interviews at the national and subnational levels. Interviews were audio recorded, transcribed and thematically analysed.

Results: Participants highlighted a range of psychological and structural barriers and facilitators to integrating and sustaining the VMMC programme. Respondents mentioned financing and staffing barriers to integration, particularly a lack of domestic resources, the transition from a fee-for-service to a facility-based performance model and staff attrition. Notably, resistance to changing the VMMC programme’s operations was a significant barrier that may be tied to individual psychological barriers such as loss of power and job security. Donors and partners continued to control the funding for VMMC. Ideally, the Ministry of Health and Child Care should have more autonomy over these decisions. At the subnational level, there is an opportunity for increased responsibility and a greater sense of ownership through the decentralisation of governance.

Conclusions: To ensure successful integration and local ownership of VMMC as an HIV prevention programme, stakeholders must address both psychological and structural barriers while aligning their perspectives on the transition. Individual providers have valid concerns about their financial security and the burden of additional responsibilities without adequate compensation. It is crucial for donors and partners to reduce their involvement and oversight. Additionally, resolving the financial barriers that prevent the government from having complete control of the programme will require empowering local government stakeholders to fully take ownership.

Item ID:	86051
Item Type:	Article (Research - C1)
ISSN:	2059-7908
Copyright Information:	© Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license.
Date Deposited:	12 Aug 2025 21:37
FoR Codes:	35 COMMERCE, MANAGEMENT, TOURISM AND SERVICES > 3505 Human resources and industrial relations > 350503 Human resources management @ 60% 42 HEALTH SCIENCES > 4203 Health services and systems > 420312 Implementation science and evaluation @ 40%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200412 Preventive medicine @ 100%
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