HIV/Aids experts and activists have welcomed a recent court ruling that specially trained pharmacists may prescribe medicine to HIV/Aids and TB patients, alleviating the burden on the health system.
Pretoria high court Judge Elmarie van der Schyff dismissed with costs an application that a doctors association, the IPA Foundation, brought against the South African Pharmacy Council (SAPC) to review and set aside its Pharmacy-Initiated Management of the Anti-Retroviral Treatment (Pimart) programme.
The initiative, which allows specially trained pharmacists to prescribe and manage medicines for HIV/Aids patients, was piloted in line with the World Health Organisation’s vision to promote widely accessible primary healthcare.
Van der Schyff said in the judgment handed down last week that pharmacists had played “an efficient role” in providing healthcare services during the Covid-19 pandemic and there was a dire need to widen access to antiretrovirals and TB Preventive Treatment (TPT) therapy.
The IPA argued in its application that the pharmacy council had not given it enough time to comment on the proposed initiative because doctors had been in the midst of dealing with the Covid-19 pandemic.
According to court papers, the pharmacy council requested the director general of health in August 2018 to consider issuing permits to pharmacists who have completed a supplementary training qualification for PrEP and PEP — pre-exposure prophylaxis and for post-exposure prophylaxis.
The Pimart qualification was subsequently developed in collaboration with the Southern African HIV Clinicians Society and the School of Pharmacy of the North-West University. The pharmacy council recommended that permits only be issued to pharmacists who had completed the training.
On 22 March 2021, the pharmacy council published a notice calling for public and stakeholder participation regarding the adoption of Pimart before the director general approved the issuing of permits on 12 August 2021.
The IPA challenged the validity of the decision to implement Pimart on the grounds of “procedural fairness” on two fronts: that the notice for public participation was published at “an opportune time” during the pandemic and that it was only published in the Government Gazette, a publication that is not generally read.
In her judgment Van der Schyff noted: “The need to widen access to first-line ART [antiretrovirals] and TPT on community level is not a figment of the SAPC’s imagination by a dire need that is also evinced in other countries.”
“The decision to utilise PIT [pharmacy initiated therapy] as a vehicle for Pimart and to enable adequately trained pharmacists to provide Pimart services is a decision that is rationally connected to the purpose for which was taken … it is also a decision that is rationally connected to the SAPC’s objective to assist in the promotion of the health of the population of the republic,” she ruled.
Treatment Action Campaign (TAC) chairperson Sibongile Tshabalala welcomed the ruling.
“The challenges that we are facing in the country include one of people queuing for a long time in facilities … and also the attitude of nurses in health facilities, which chases away so many people from facilities.”
“We also have the issue of key populations — people who use drugs, sex workers and LGBTQIA+ communities — who are not comfortable to go to public health facilities to access medication. So if a pharmacist is able to issue and prescribe ARVs and TB medication it will mean that we will be able to cover a lot of people.”
Tshabalala said South Africa is also chasing the UNAIDS’ target to end HIV/Aids by 2030, and it has not achieved the target of ensuring that 95% of all people living with HIV are tested and know their status, that 95% of those seek and have access to uninterrupted treatment, and that 95% of those are virally suppressed —the 95-95-95 target.
“The country currently sits on 94-77-92. Due to many issues including but not limited to lack of access to ART to achieve virally suppressed. Therefore, the court ruling is contributing towards the ambitious trajectory of ending HIV by 2030,” Tshabalala said.
“Pimart is one approach that will improve access to antiretroviral therapy for people living with HIV and those requiring PEP & PrEP.”
Francois Venter, the former president of the Southern African HIV Clinicians Society and the director of Ezintsha, an HIV research organisation at the University of the Witwatersrand, said the ruling was in line with global trends.
“Pharmacists getting involved fits with international trends. South Africa is going to need all hands on deck to achieve its HIV targets, and pharmacists are highly trained and under-utilised,” Venter said.
“Pharmacies are convenient and accessible. We need them to prevent and treat HIV, as we do not have enough health professionals or facilities.”