Specially trained pharmacists will now be allowed to manage and prescribe medicine to patients with HIV and/or tuberculosis, after the judicial green light from the South African Pharmacy Council (SAPC) to launch its Pharmacy-Initiated Management of Antiretroviral Treatment (PIMART) initiative.
An application by a doctors’ organisation – the IPA Foundation – to set aside the programme was dismissed by Gauteng High Court (Pretoria) Judge Elmarie van der Schyff, who said the pilot project had highlighted the value of the initiative, writes Tania Broughton for GroundUp, which was aligned with the WHO’s vision to promote widely accessible primary health care.
“The untapped value of pharmacists in fighting HIV was also emphasised by the efficient role pharmacies played in meeting healthcare needs and services during the Covid-19 pandemic,” she said.
“The need to widen access to first line ART and TPT therapy on a community level is … a dire need also evinced in other countries.”
The IPA Foundation had approached the court, under the Promotion of Administrative Justice Act (PAJA), seeking to review and set aside the SAPC’s decision to implement PIMART, claiming the SAPC had failed to give interested parties adequate opportunity to comment before the initiative was implemented.
It further contended that PIMART unjustifiably encroached on the domain of medical practitioners and was in conflict with legislation.
IPA also accused SAPC of misleading the director-general of Health, claiming there had been extensive consultation with stakeholders, which led to the approval and issuing of permits for the initiative.
However, the SAPC said the application should be dismissed, that pharmacy-provided primary healthcare was a well known and functional concept in the country, and that PIMART was simply a “widening of this”.
Referring to the background and context, Van der Schyff said in line with WHO recommendations that people with HIV must be provided with ART, the Health Department had asked the SAPC to consider and implement interventions to increase patients’ 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 PIMART.
In March 2021, the SAPC published a notice for public comment regarding the adoption of PIMART, with the first permits being issued in August that year.
However, IPA submitted objections outside the timeline, because, it said, members were struggling with another wave of the pandemic.
“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,” said the judge.
She noted, however, that the National Drugs Policy, in line with WHO guidelines, promoted “task shifting” to advance access to medicine and that at primary level, prescribing should be competency-based, not occupation-based.
In considering procedural fairness, she said there was nothing sinister in the timing of the notice calling for comment, that 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.
The judge dismissed the review application and ordered IPA to pay the costs.
groundup judgment
See more from MedicalBrief archives:
Doctors challenge law allowing pharmacists to give HIV meds without scripts
Doctors in new turf war with pharmacists over ‘unlawful and unfair’ competition
England's pharmacists allowed to prescribe antibiotics without GP approval
Top HIV experts call for PrEP to be prescribed by all nurses and midwives