ArticleGlobal health action2018
Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe.
Article in Global health action, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010-2023-A systematic review and meta-analysis.PloS one · 2024Pooled it
- Reducing Provider Workload While Preserving Patient Safety: A Randomized Control Trial Using 2-Way Texting for Postoperative Follow-up in Zimbabwe's Voluntary Medical Male Circumcision Program.Journal of acquired immune deficiency syndromes (1999) · 2020Trial
- Male Circumcision Revisited: A Narrative Review of Techniques, Therapeutic Indications, and Preventive Benefits.Cureus · 2025Review
- Integration of a vertical voluntary medical male circumcision program into routine health services in Zimbabwe: A solution for sustainable HIV prevention.PLOS global public health · 2025Article
- Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis.BMC health services research · 2023Article
- Preventing HIV Among Adolescent Boys and Young Men Through PEPFAR-Supported Voluntary Medical Male Circumcision in 15 Sub-Saharan African Countries, 2018-2021.AIDS education and prevention : official publication of the International Society for AIDS Education · 2023Article
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- Community engagement for the Voluntary Medical Male Circumcision (VMMC) program: an analysis of key stakeholder roles to promote a sustainable program in Zambia.Gates open research · 2022Article
- Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe's voluntary medical male circumcision program.PloS one · 2020Article
- Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia.PloS one · 2020Article
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- Incorporating Voluntary Medical Male Circumcision Into Traditional Circumcision Contexts: Experiences of a Local Consortium in Zimbabwe Collaborating With an Ethnic Group.Global health, science and practice · 2019Article
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- 90-90-90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe - 2017 to 2020.Journal of the International AIDS Society · 2018Article
- Timing of adverse events among voluntary medical male circumcision clients: Implications from routine service delivery in Zimbabwe.PloS one · 2018Article
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Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundDespite increased support for voluntary medical male circumcision (VMMC) to reduce HIV incidence, current VMMC progress falls short. Slow progress in VMMC expansion may be partially attributed to emphasis on vertical (stand-alone) over more integrated implementation models that are more responsive to local needs. In 2013, the ZAZIC consortium began implementation of a 5-year, integrated VMMC program jointly with Ministry of Health and Child Care (MoHCC) in Zimbabwe.
objectiveTo explore ZAZIC's approach emphasizing existing healthcare workers and infrastructure, increasing program sustainability and resilience.
methodsA process evaluation utilizing routine quantitative data. Interviews with key MoHCC informants illuminate program strengths and weaknesses.
methodsA process evaluation utilizing routine quantitative data. Interviews with key MoHCC informants illuminate program strengths and weaknesses.
resultsIn start-up and year 1 (March 2013-September, 2014), ZAZIC expanded from two to 36 static VMMC sites and conducted 46,011 VMMCs; 39,840 completed from October 2013 to September 2014. From October 2014 to September 2015, 44,868 VMMCs demonstrated 13% increased productivity. In October, 2015, ZAZIC was required by its donor to consolidate service provision from 21 to 10 districts over a 3-month period. Despite this shock, 57,282 VMMCs were completed from October 2015 to September 2016 followed by 44,414 VMMCs in only 6 months, from October 2016 to March 2017. Overall, ZAZIC performed 192,575 VMMCs from March 2013 to March, 2017. The vast majority of VMMCs were completed safely by MoHCC staff with a reported moderate and severe adverse event rate of 0.3%.
conclusionThe safety, flexibility, and pace of scale-up associated with the integrated VMMC model appears similar to vertical delivery with potential benefits of capacity building, sustainability and health system strengthening. These models also appear more adaptable to local contexts. Although more complicated than traditional approaches to program implementation, attention should be given to this country-led approach for its potential to spur positive health system changes, including building local ownership, capacity, and infrastructure for future public health programming.
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