If pharmacists are permitted to prescribe to people on HIV treatment it could erode the income of medical practitioners, the Health Professions Council of SA (HPCSA) warns.
“Perhaps it is not politically palatable but it is a reality that I think must be confronted,” chair of the medical and dental board of the HPCSA, Arthur Rantloane, told delegates at the annual Board of Healthcare Funders (BHF) conference on Tuesday.
The BHF is an industry association for medical schemes and administrators. Many doctors, particularly those operating in poorer communities, dispense medicines to their patients.
The controversial policy of pharmacist-initiated management of antiretroviral therapy (Pimart) was approved by the Pharmacy Council in 2021 but is on hold due to a legal challenge brought by the Independent Practitioners’ Association (IPA), which represents doctors.
The IPA’s central argument in its opposition to the policy is that it encroaches on the preserve of doctors. Under Pimart, appropriately trained pharmacists were given the go-ahead to prescribe antiretroviral therapy to people with HIV, to protect people from acquiring the virus, or as post-exposure prophylaxis.
While the IPA’s high court application to scrap the policy was dismissed last August, it has been granted leave to appeal, which has the effect of suspending the ruling. The Supreme Court of Appeal has yet to set a date for the matter, according to SA Pharmacy Council registrar Vincent Tlala.
The council believed there was a clear need for pharmacists to be able to prescribe antiretroviral treatment, Tlala said. For example, if a patient sought the morning-after pill at a pharmacy, the pharmacist should be able to prescribe post-exposure prophylaxis on the spot, along with the provision of an HIV test and counselling, he said.
As things stand, the patient must obtain a prescription for post-exposure prophylaxis from a doctor.
Pharmacist and public health specialist Bronwyn Macauley said community pharmacists could help manage SA’s HIV epidemic, which is the biggest in the world. More than 7.8-million people in SA are estimated to be living with HIV.
“As healthcare professionals we can’t just sit back and dispense. We are able and want to do more,” she told delegates.
Not only did community pharmacists offer a safe and non-judgmental environment for patients, but they were more accessible than government clinics, since they were open after hours and on weekends.
University of Pretoria pharmacologist Natalie Schellack previously told Business Day that Pimart had potential to reach many of the people living with HIV who had yet to be tested and start treatment, particularly men and adolescents. Pimart had the potential to provide them with a less stigmatising environment in which to seek care, she said.
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