An interview with Felix Mwanza, National Director of the Treatment Advocacy and Literacy Campaign in Zambia.
Felix is an advocate representing people living with HIV on the national DSD task force to scale up differentiated service delivery approaches in Zambia.
Please tell us about yourself and why you decided to become engaged in the HIV response.
I am an HIV activist, and a development worker and information technology (IT) specialist by training. In 2003, after learning that I was HIV positive, I stopped practising as an IT specialist in the private sector and became involved in the HIV response.
I started participating in HIV activism to fight for HIV treatment, which was very difficult to access at that time. In 2006, I started working as the Coordinator of the Treatment Advocacy and Literacy Campaign (TALC). TALC, registered in 2005, is a leading HIV and AIDS organization in Zambia that advocates for equitable access to HIV treatment and health policy reform. Currently, I am working as TALC’s National Director. I also sit on the board of ICAP’s HIV Coverage, Quality, and Impact Network (CQUIN) as a representative of people living with HIV.
Can you tell us more about your engagement in Zambia’s DSD task force?
I have been a member of the national DSD task force since its formation in 2017, representing the community and people living with HIV. I was nominated by the ministry of health following my past performance and experience in the national HIV response. As a member of the national DSD task force, I have been part of the team that has developed the national DSD policy, national DSD framework and DSD training manuals. This year, the key goal of the task force is to finalize and publish the DSD training manuals for facilitators and participants, as well as to strengthen the health system supply chain. When this is finalized, the task force will conduct a countrywide DSD training.
From a recipient of care perspective, what actions and initiatives should the task force prioritize?
The task force should prioritize implementation of DSD models in all districts in Zambia. The implementation should start with community-based DSD models, such as community ART access points (CAAPs), an initiative mooted by recipients of care, and community adherence groups (CAGs) that have been shown to improve retention among recipients of care in the few facilities where they have been implemented.
Which DSD models currently implemented in Zambia do recipients of care most prefer?
Recipients of care most prefer facility-based MMS and fast-track models. The MMS model is preferred because a six-month drug supply covers the time until recipients of care are due for their next laboratory and clinical review appointment. What is unclear is the preference of recipients of care for group models or community-based models; the ministry has approved only these two individual, facility-based models.
What do you see as challenges with how the DSD task force operates?
One of the main challenges is ensuring the sustainability of the task force. At the moment, the operations are funded through implementing partners who are mainly supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. While the support from PEPFAR and the Global Fund is welcome, we wonder how DSD work will be sustained in the absence of support from these main donors.
The other challenge with the DSD task force is the slow pace at which its activities have been moving since its establishment in 2017. So far, the DSD initiative has not been officially launched. This is why the ministry of health has approved only the facility-based fast-track and MMS models. This slow pace is mostly attributable to the task force’s over-dependence on implementing partners’ resources to conduct most activities, such as workshops and meetings.
