{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:05:30Z","timestamp":1755223530533,"version":"3.43.0"},"reference-count":41,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-002137","INV-053388"],"award-info":[{"award-number":["INV-002137","INV-053388"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,7,6]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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\u2019 perspectives on barriers, facilitators and recommendations as a vertical HIV prevention programme transitioned to an integrated, government-led model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted 54 semistructured stakeholder interviews at the national and subnational levels. Interviews were audio recorded, transcribed and thematically analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2019s 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018732","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T02:31:07Z","timestamp":1754965867000},"page":"e018732","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention programme into routine health services in Zimbabwe: a qualitative study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-9616","authenticated-orcid":false,"given":"Amanda Marr","family":"Chung","sequence":"first","affiliation":[{"name":"Center for Innovation in Global Health, Stanford University, Stanford, California, USA"},{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2257-8559","authenticated-orcid":false,"given":"Joseph","family":"Murungu","sequence":"additional","affiliation":[{"name":"HEALTHQUAL, University of California San Francisco, Harare, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1214-8371","authenticated-orcid":false,"given":"Peter","family":"Case","sequence":"additional","affiliation":[{"name":"Bristol Business School, University of the West of England, Bristol, UK"},{"name":"School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa"},{"name":"College of Business, Law & Governance, James Cook University, Townsville City, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7492-6364","authenticated-orcid":false,"given":"Precious","family":"Chitapi","sequence":"additional","affiliation":[{"name":"Precious Innovations, Harare, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8067-9870","authenticated-orcid":false,"given":"Rudo","family":"Chikodzore","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund Zimbabwe, Harare, Harare Province, Zimbabwe"},{"name":"Ministry of Health and Child Care, Gwanda, Matebeleland South, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Gosling","sequence":"additional","affiliation":[{"name":"Bristol Business School, University of the West of England, Bristol, UK"},{"name":"Pelumbra Limited, Exeter, 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