Access to HIV treatment has expanded as the Supreme Court supports pharmacist-led therapy
HEALTH
The SCA supported the Pimad initiative to enhance HIV treatment access to patients when it turned down an appeal by a group of doctors who had objected to this as they felt this was stepping on their domain.
Image: Tumi Pakkies/ Independent Newspapers
The Supreme Court of Appeal has ruled against an association representing a small group of doctors who sought to halt the implementation of Pharmacist-Initiated Management of Antiretroviral Therapy (Pimart), increasing access to treatment and prevention medications for people living with HIV and Aids.
This is an intervention premised on improving access to HIV and Aids treatment and associated medicines.
Given the shortcomings of earlier efforts, the South African Pharmacy Council (SACP), which regulates the pharmacy profession, launched Pimart with the goal of expanding access to healthcare for HIV first-line treatment. Since Pimart supports the fight against HIV and advocates for the right to access healthcare, the SCA determined that it was logically related to that goal.
The Independent Practitioners Association Foundation (IPA), in 2023 turned to the Gauteng High Court, Pretoria, to stop the implementation of Pimart.
The court ruled against them in finding that Pimart is a necessary and competently designed intervention programme to support South Africa’s efforts in providing access to patients diagnosed with HIV and Aids. It recognised that Pimart increases access to much-needed HIV prevention and treatment care, with an immediate benefit of improved quality of life and increased life expectancy for more persons living with HIV and Aids.
Unhappy with this finding, the IPA Foundation turned to the SCA to appeal it. The SACP maintained that Pimart improves efficiencies in the congested health-care system. Diagnosed patients have the opportunity to be initiated sooner within the multidisciplinary health-care team, which includes pharmacists.
Pimart remains an appropriate intervention to support the existing treatment and prevention mechanisms for HIV and Aids. Pimart would help reach a large number of underserved, undertested and hard-to-reach populations, who are currently without access to HIV prevention and treatment services, the pharmacy authority said.
The IPA Foundation, however, objected to this initiative and argued that it encroached on the domain of medical practitioners and was not in tune with legislation. It also argued that it should have been consulted before this initiative was adopted.
Judge Tati Makgoka, who wrote the SCA judgment, however said contrary to the IPA’s contentions, Pimart is an essential intervention in the fight against HIV/Aids.
“Its introduction constitutes a rational legislative and practical measure within the competence of the SAPC as an organ of the State in enhancing access to healthcare for HIV treatment, in fulfilment of the State’s obligation under the Constitution,” he said.
The Pimart initiative allows accredited pharmacists to administer first-line therapy for the treatment and management of HIV/Aids. Its implementation required amendments to the Pharmacy Act to expand the scope of practice for specifically qualified pharmacists providing these services. Such pharmacists would be able to, among others, conduct consultations with HIV patients at a pharmacy or at an approved healthcare setting.
In 1995, the SAPC issued regulations concerning pharmacist-initiated therapy that could be obtained through supplementary or continuing professional development courses for pharmacists. These regulations allowed pharmacists to provide services such as HIV testing.
In 2000, antiretrovirals (ARVs) were first introduced into the private sector. Only specialists were permitted to initiate treatment and could only be carried out by healthcare providers and was predominantly hospital-based. In 2020, the Department of Health granted special authorisation that permitted nurses in private pharmacies to prescribe ARVs at pilot sites, provided these nurses had completed the compulsory training.
Despite all these initiatives, the number of HIV infections remained persistently high, despite improved access. This high rate of new HIV infections underscored the necessity for intensified prevention efforts. In light of this, the department requested the SAPC to investigate an intervention aimed at increasing patients’ access to antiretroviral medicines, which led to the introduction of Pimart.
zelda.venter@inl.co.za