HIV and AIDS is one of the major challenges facing South Africa. With an estimated 7.6 million persons infected (as at 2022), the country is home to the largest number of persons living with HIV worldwide.

Approximately 1 in every 5 women aged between 15-49 and 12.1% of men in the same age group are living with the virus.

Despite the nation’s fundamental wins such as decreased rates of infection and reduced deaths due to the disease, there is still room for improvement.

The ART treatment coverage for example, at 73.1% still sits below UNAIDS target of 95% of those diagnosed. This means that 1 in every 4 persons living with HIV has not been started on anti-retroviral therapy.

What is PIMART?

Pharmacists traditionally have played a pivotal role in the fight against HIV and AIDS. Including ensuring efficient supplies of ART medicines, establishing and improving adherence as well as monitoring adverse drug reactions.

PIMART is expected to expand this role.

PIMART stands for Pharmacist Initiated Management of Antiretroviral Therapy and is an approach where pharmacists-through supplementary training, are allowed to test for HIV and dispense first-line treatment.

The overall goal of this initiative is to improve testing and access to ARVs and TB therapy. In essence improving treatment coverage. This strategy is expected to increase life expectancy of Persons Living with HIV (PLWHA), improve viral suppression and reduce new infections.

What happened?

The South African Pharmacy Council (SAPC), which regulates the profession in the country, has been spearheading registration and issuance of the permits related to PIMART supplementary training.

In 2021, PIMART was gazetted and incorporated into the country’s Rules of Good Pharmacy Practice but was met with opposition from general medical practitioner interest groups. Their position was clear; pharmacists were not qualified to initiate antiretroviral therapy.

Later in February 2022, the Independent Practitioner Association (IPA) Foundation, a doctor’s association, moved to court seeking to halt SAPC’s decision to implement PIMART.

In their reasoning, the initiative was encroaching into the medical practitioners’ scope of work and this was against the law.

SAPC held firmly that the application from this doctors’ group should be dismissed for the benefit of the people of South Africa.

What was said?

Pretoria High Court Judge Elmarie van der Schyff, in her ruling, duly dismissed the doctors’ application noting that she didn’t see any contravention to the current legislation.

In fact, she acknowledged the value of the programme and how it was consistent with the World Health Organization’s vision to promote widely accessible primary healthcare.

“The untapped value of pharmacists in fighting HIV was emphasized by the efficient role pharmacies played in meeting healthcare needs and providing healthcare services during the Covid-19 pandemic,”

High Court Judge Elmarie van der Schyff

“The need to widen access to first line ART and TPT (TB-Preventive Therapy) on a community level is not a figment of SAPC’s imagination, but a dire need that is also evidenced in other countries.”

 

What’s more

“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. This is evidenced by its fear that the decision to implement PIMART might ‘open the floodgates’ and ‘pave the way for pharmacists to ultimately treat and prescribe other schedule 4 drugs in respect of acute illnesses.” she added.

See full judgement here

Bigger Picture

The fight against the scourge of HIV and AIDS is a daunting one and it is vital to have all hands on deck.

Noting that pharmacies in Africa are majorly the first point of contact for primary health care, it is important to leverage on pharmacists to increase treatment coverage with ART.

As the judge stated, South Africa should serve as an example to more countries in the region to adopt the same strategy.

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