A new court judgment, which effectively allows suitably trained pharmacists to administer antiretroviral treatment (ARVs), will help tackle SA’s 1.1-million untreated HIV/Aids cases, the SA Pharmacy Council (SAPC) said on Monday.
“While great strides have been made, with more than 5.9-million people being on antiretroviral therapy, the nation has not yet reached all persons needing HIV treatment,” SAPC president Mogologolo Phasha said during a media and stakeholder briefing.
“As [per] the last department of health annual report, at least 1.1-million people who knew their statuses were untreated. We think we should be able to play a role in reducing the numbers,” SAPC registrar Vincent Tlala added.
The SAPC was responding to the judgment handed down by the Supreme Court of Appeal (SCA) on Friday, which dismissed, with costs, an appeal by the Independent Practitioners Association Foundation (IPA), a doctors' representative body, aimed at preventing suitably trained pharmacists from treating people living with HIV.
“The SAPC, together with stakeholders and the department of health, will work with speed to ensure that Pharmacist-Initiated Management of Antiretroviral Therapy (Pimart)-trained pharmacists join other primary healthcare practitioners in providing primary care in relation to HIV and Aids,” Phasha said.
What Pimart means for HIV care
Pimart is a type of therapy that aims to allow pharmacists to join nurses and other clinicians in the fight against the rising HIV infections in SA. Through this programme, pharmacists would be able to, after completing supplementary training and obtaining a special permit for dispensing schedule 4 drugs, advise clients on taking ARVs and following their treatment.
While the regulator welcomed the SCA verdict, Phasha said they were “beyond disappointed that over the period that Pimart has been litigated against, the country’s potential to treat untested, untreated and hard-to-reach populations has been sorely restrained”.
Pimart was approved by the Pharmacy Council in 2021, but its implementation was put on hold by the legal challenge of the IPA. The IPA said pharmacists were encroaching on the domain of doctors and asked the Pretoria high court to scrap the pharmacy council’s decision to introduce Pimart into the scope of practice of suitably trained pharmacists.
In August 2023, High Court judge Elmarie van der Schyff dismissed the IPA challenge for the first time, opening the way for pharmacists to prescribe antiretroviral therapy for people with HIV. The IPA then approached the SCA.
Training and rollout next steps
Regarding next steps, Dr Sham Moodley, chair of the SAPC practice committee, said the first priority following the SCA judgment was to issue permits to the just over 1,000 pharmacists who have completed the training course — a process that requires sign-off by the director-general.
“The second part is to expand that training programme and include more trained pharmacists into the programme ... so that we could expand the services across the country,” he said.
Responding to a question about whether there is any engagement with medical aids to cover costs, Tlala said they have been consulting with the Board of Healthcare Funders, which represents various medical schemes — and that this case will be no different.
“We would be consulting with them to make sure that pharmacists are paid specifically for those private patients who are not state-owned patients. Insofar as it relates to the state-owned patient, we expect that the pharmacist will work closely with the provincial department of health.”
Bringing SA closer to global HIV targets
This latest judgment will bring SA closer to the targets set by the Joint UN Programme on HIV Aids (UNAids), known as the 95-95-95 goals.
SA has committed to achieving these targets, which aim to ensure that 95% of people living with HIV know their status, 95% of those diagnosed receive antiretroviral treatment, and 95% of those on treatment achieve viral suppression — thereby reducing the risk of transmitting the virus.
While the country is broadly on track to meet the first target, a significant number of HIV-positive individuals who know their status are still not receiving treatment.
With Tamar Kahn
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