The SA Pharmacy Council (SAPC) has been given the judicial go-ahead to introduce its Pharmacy-Initiated Management of Antiretroviral Treatment (Pimart) initiative, which will allow specially trained pharmacists to manage and prescribe medicine to patients with HIV and tuberculosis.
Pretoria high court judge Elmarie van der Schyff has dismissed an application brought by a doctors’ organisation — the Independent Practitioner Association (IPA) Foundation — for the setting aside of the programme.
She said the pilot project had emphasised the value of the initiative, which is in line with the World Health Organisation’s (WHO) vision to promote widely accessible primary healthcare.
“The untapped value of pharmacists in fighting HIV was also emphasised by the efficient role pharmacies played in meeting healthcare needs and providing healthcare services during the Covid-19 pandemic,” she said.
The need to widen access to first-line antiretroviral therapy (ART) and TB preventative treatment at community level “is not a figment of SAPC’s imagination, but a dire need that is also evinced in other countries”.
The IPA Foundation approached the court, under the Promotion of Administrative Justice Act, seeking to review and set aside the SAPC’s decision to implement the initiative. It said the SAPC failed to give interested parties an adequate opportunity to comment before the initiative was implemented. It contended that the initiative unjustifiably encroaches on the domain of medical practitioners and is in conflict with legislation.
The need to widen access to first-line ART and TPT therapy on a community level is not a figment of SAPC’s imagination, but a dire need that is also evinced in other countries.
— Judge Elmarie van der Schyff
The foundation accused the SAPC of misleading the director-general of health by saying there had been extensive consultation with stakeholders, which led to the approval and issuing of permits for the initiative.
The SAPC said the application should be dismissed. It said pharmacy-provided primary healthcare is a well-known and functional concept in SA and the initiative widens this.
Van der Schyff said that in line with WHO recommendations that all people living with HIV must be provided with ART, the department of health had requested the SAPC to consider and implement interventions that would ensure patients have increased access to medicines.
This led to the SAPC requesting the director-general in August 2018 to consider issuing permits to pharmacists who had completed supplementary training to manage patients and to dispense medication under the initiative.
In March 2021, the SAPC published a notice for public comment. The first permits were issued in August that year.
Professional tensions
However, the IPA Foundation submitted objections outside the timeline for comments. It said this was because its members were struggling with another wave of the Covid-19 pandemic.
The judge said: “Pharmacists and doctors operate in distinct and separate professional domains, the boundaries of which are closely guarded and some tension exists ... IPA’s objection to Pimart seems to be rooted, partially at least, in this professional tension.
“This is evidenced by its fear that the decision to implement Pimart might ‘open the floodgates’ and ‘pave the way for pharmacists to treat and prescribe other schedule 4 drugs in respect of acute illnesses.”
She noted, however, that the National Drugs Policy promotes “task shifting” to advance access to medicine and that at primary level, prescribing should be based on competency, not on occupation.
Any alleged adverse effect that Pimart held for a medical practitioner has to be considered against the need to expand primary healthcare services aimed at preventing and treating HIV and providing first-line ART.
Van der Schyff said the initiative gives members of the public a choice as to whether they want to approach a general practitioner or a pharmacist who has been issued with a permit.
The judge said there was nothing sinister in the timing of the notice calling for comment; the project was not something hidden in secrecy; and “I find it improbable, as alleged, that none of IPA’s members had timeous knowledge of the board notice”.
Evidence also showed that the Pimart training course was developed to ensure pharmacists who successfully completed the training would be suitably qualified to safely and effectively assist in providing ART.
Van der Schyff dismissed the review application and ordered the foundation to pay the costs.
Prof Francois Venter, former president of the Southern African HIV Clinicians Society and director of Ezintsha, an HIV research organisation at Wits University, said: “I hope this is the end of it. The pharmacies are an essential part of the health system, and pharmacists internationally play a big role in expanding HIV services.”
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