Update on the implementation of (PIMART)

Pharmacist-Initiated Management of Antiretroviral Therapy

All processes relating to Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) are currently on hold, pending the outcomes of a court case and a multi-council task team on PIMART. PIMART was proposed in response to the rising HIV infections nationally, below-target viral suppression and treatment adherence rates, as well as the high number of HIV-related deaths. It intends to add pharmacists with the required supplementary training to the national health manpower currently fighting HIV, thus providing greater access to HIV testing, prevention and treatment services.

Update on the implementation of Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART)

The South African Pharmacy Council (hereafter “Council”) wishes to inform the profession that the recording of Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART)-related supplementary training with Council and the issuance of Section 22A(15) permits by the Director-General: Health is currently on hold.

This stems from court proceedings against Council by an interest group of general medical practitioners in private practice, as well as a multi-council consultative process initiated by the Ministry of Health in September 2021.

Furthermore, all new accreditation applications for PIMART training programmes are suspended, pending the outcome of these processes.

Council will continue to work towards the realisation of increased access to HIV prevention and treatment through PIMART, to ensure increased life expectancy and improved quality of life for people living with HIV and to reduce the rate of new infections, which continues to be unacceptably high despite all efforts to date.

What is PIMART?

Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) is a type of pharmacist-initiated therapy which aims to allow pharmacists to join nurses and clinicians in the fight against the rising HIV infections in South Africa. In addition, PIMART will help address the lack of adherence to treatment by persons living with HIV (PLWHA), and the high number of avoidable HIV-related deaths by allowing them access to antiretroviral treatment through Section 22A(15) of the Medicines and Related Substances Act, 101 of 1965. Following supplementary training, PIMART allows pharmacists to test for HIV and administer first-line treatment to patients or, in complex cases, refer patients to clinicians and/or specialists for the management of their conditions.

Programmes similar to PIMART have been successfully deployed in several countries across the world and can help South Africa attain its HIV targets. The programme may also arrest and lower the ballooning HIV budget (which is currently nearly half the national health budget) by reducing the rate of new infections, increasing life expectancy among PLWHA by ensuring adherence to treatment and improved viral suppression, and increasing the number of persons testing for HIV and referring complex cases along the referral pathways.

The implementation of PIMART

PIMART was gazetted for implementation and became part of the Rules relating to Good Pharmacy Practice (GPP) through the publication of Board Notice 101 of 2021 in the Government Gazette on 13 August 2021. This publication followed extensive stakeholder consultation and a 60-day gazetted comment period from 22 March 2021 in line with Section 49(4) of the Pharmacy Act, 53 of 1974. All comments received were positive and in support of the implementation of PIMART given the rising HIV infections and the increased need for universal access to HIV prevention and treatment.

Minority medical practitioner interest groups’ contest of PIMART through the Ministry of Health

On 15 September 2021, Council representatives attended a meeting at the request of the Deputy Minister of Health as certain general medical practitioner interest groups had requested the Ministry to halt the implementation of PIMART, as, in their view, pharmacists were not qualified to initiate therapy. This group also submitted to the Ministry that they were unable to comment in the 60-day comment period as they were focused on COVID-19. At this meeting, Council indicated that pharmacist-initiated therapy is as old as the practice of pharmacy, and pharmacists continue to initiate therapy with medicines and related substances rated Schedule 2 and below.

However, Council was subsequently instructed to suspend PIMART and consult other statutory health councils on its implementation. Council met with other statutory health councils on 27 September 2021. It was agreed at this meeting that a multi-council task team comprising representatives from Council, the Health Professions Council of South Africa (HPCSA) and Nursing Council of South Africa (SANC) be formed. On 13 October 2021, Council then appointed a task team to coordinate matters concerning PIMART and to represent Council on the multi-council task team.

The IPA Foundation (IPAF) challenges Council in court, in an attempt to stop PIMART

On 9 February 2022, Council was served a notice of motion concerning litigation by the IPAF. Council is currently attending to this matter and intends to bring it to a close for the benefit of persons affected by HIV/AIDS, either directly or indirectly, and all of South Africa’s people.

What now?

The issuance of Section 22A(15) permits in relation to PIMART and the recording of PIMART supplementary training with Council are on hold until all these processes are resolved.

Council will continuously update the profession on further developments until the court case and consultation processes are concluded.

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