Ten months after an enabling court judgment, some specially trained South African pharmacists can finally start applying for permits allowing them to dispense ARVs without a doctor’s script, writes Catherine Tomlinson for Spotlight.
The long-awaited permitting process was announced to pharmacists in a South African Pharmacy Council (SAPC) e-Note on 13 August, 10 months after the Supreme Court of Appeal cleared the way for the implementation of pharmacist-initiated management of antiretroviral treatment (PIMART) in South Africa.
What is PIMART?
PIMART is a form of task-shifting allowing pharmacists to provide some limited HIV services that are currently only provided by doctors and nurses.
Under the programme, pharmacists who’ve done a dedicated training programme and received a special permit from the Director-General of Health will be authorised to provide first-line antiretroviral treatment to people with uncomplicated HIV without a doctor’s script.
They will also be allowed to dispense HIV prevention medicines without a doctor’s script – which includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
Long road to implementation
The SAPC first proposed PIMART to the Health Department in 2018, in response to a request for pharmacists to assume a larger role in the country’s HIV response.
In 2021, Spotlight reported the imminent launch of PIMART services in local pharmacies, but then a court challenge by a group of general practitioners blocked the programme’s implementation.
Four years later, in October 2025, a ruling by the Supreme Court of Appeal finally cleared the way for SAPC to launch PIMART, with Vincent Tlala, CEO and Registrar of the SAPC, telling media that the SAPC would issue a memo in November 2025 inviting pharmacists to apply for the special permits.
But this would, in fact, only materialise in August 2026.
The SAPC’s 13 August memo to pharmacists said that certain pharmacists can now begin to apply for temporary PIMART permits to provide PEP, PrEP, and HIV testing services – but not HIV treatment services yet. The temporary permits will be valid for 24 months.
Also, only pharmacists who have completed the South African HIV Clinicians Society’s (SAHCS) previous PIMART training course can apply for the limited-scope, temporary permits.
Pharmacists who haven’t done this course will have to wait for a new training course to be accredited and launched before they can apply for permits.
How long to get a permit?
Tlala told Spotlight that the granting of the permits by the DG and their recording by the SAPC may take a few months.
“The Department of Health processes applications for permits within 90 days (maximum),” said Tlala. “The permit recording process with the SA Pharmacy Council then takes between 72 working hours and 14 days, depending on the completeness of the application.”
The permits will only be granted to pharmacists who have already completed the Southern African HIV Clinicians Society’s (SAHCS) continuous professional development (CPD) PIMART course.
Fiona Story, CEO of SAHCS, told Spotlight that nearly 800 pharmacists have done the course.
All of this suggests that toward the end of the year, a few hundred pharmacists in South Africa might be dispensing HIV prevention medicines without doctors’ scripts.
When will updated course be available?
At the moment, there is no PIMART training course available, because the previous one provided by SAHCS is on pause, while the updated course awaits accreditation. Based on dates provided by SAHCS, this might only be available early next year.
However, once the updated course is available, it is hoped that pharmacists who completed it will be able to apply for full-scope PIMART permits allowing them to dispense first-line ARVs as well as PEP and PrEP.
The timeline for when they will be able to provide the full scope of services intended under PIMART remains unclear. Before this happens, the SAPC has to accredit the SAHCS’ updated supplementary training course and the SAHCS must launch this course.
After this, the permits granted to pharmacists by the DG will need to be expanded to include the provision of first-line ARVs for treating uncomplicated HIV.
In the meantime, the 800 or so pharmacists who did he SAHCS’s previous PIMART training course can begin applying for permits.
See more from MedicalBrief archives:
How to kickstart stuck pharmacy ARV roll-out
Why pharmacists still can’t prescribe ARVs after SCA ruling