Mixed views on pharmacies dispensing ARVs
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Durban: The SA Pharmacy Council has said a recent gazette, proposing that pharmacists be allowed to manage patients for antiretroviral treatment, Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), aimed to increase the public’s access to health services.
However Dr Norman Mabasa, practising general practitioner and former Chairman of the SA Medical Association (SAMA) has blasted the proposal and questioned why it was isolated to one area of disease.
The SA Pharmacy Council published a gazette titled Pharmacist Who Provides Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) Services on March 22, 2021.
Vincent Tlala, Registrar and chief executive of the South African Pharmacy Council (SAPC) explained to The Mercury that the introduction of PIMART by the council meant South Africans would now have increased access to HIV testing, first-line treatment and prevention as more than 3 600 community pharmacies will become potential sites for access not only for testing but for treatment.
The role of pharmacists would primarily be to provide first-line treatment in line with the approved primary health care guidelines of the health department, he said.
Tlala said this would help in ensuring that people who test positive for HIV are placed on treatment as soon as possible.
“Persons with the risk of contracting the virus will also be able to access HIV prevention medication PrEP and PEP much easier than before. Given that South Africa has the highest number of HIV-positive people in the world, expanding access to treatment through pharmacies will also reduce the number of people dependent on the public health system, as there is an average of 15 community pharmacies per municipality in South Africa.
“Pharmacies, due to their longer operating hours, accessibility and affordable professional fees, would also ensure that those persons who were likely to default due to cost and inability to collect treatment at specific times of the day would continue to stay on treatment,” he said.
However Dr Mabasa, said he was vehemently opposed to the move and had drafted a two-page response to the proposal. He said that the management of a patient with the now widely regarded chronic disease still needed a medical expert to manage it.
“It takes seven years and an additional two years of community service to master how to diagnose and treat HIV. Whilst pharmacists are so protective of their training, such that they would wish they were the only creatures on earth who know how to treat all ailments under the sun, they go on to wish to annihilate competition,” said Mabasa.
He added that the effective management of a patient requires a holistic understanding of a patient’s anatomy, physiology and pathology.
“It is a risk for medical negligence and exposure to litigation,” said Mabasa.
Jackie Maimin, chief executive of the Independent Community Pharmacy Association, said Mabasa’s concerns were misplaced.
She said the inclusion of the PIMART curriculum aimed to expand access to PrEP and reduce over 200 000 young women and men being exposed to HIV in the first place and to prevent either government or private health being forced to carry the burden of the cost of chronic care.
Maimin added that during the 60-day consultation period for the gazette doctors and clinicians specialising in HIV care had widely welcomed the gazette.
“Doctors are not going to be losing their role. The pharmacists will counsel, test, and dispense the life-saving medicine. Where needed they would then refer the patient to a doctor for long term care.”
“A pharmacy is a neutral ground, we have resistance from men to go to clinics but a pharmacy is a discreet place to reach men who often don’t want to be seen going to a clinic for testing for HIV.”
Tlala said the gazette was already at an advanced stage.
“The scope of practice of a pharmacist who provides PIMART services, the competency standards of such pharmacists and the criteria for the approval of curriculum for the PIMART short course are awaiting publication for implementation in August 2021.”
Despite progress towards the Joint United Nations Programme on HIV/AIDS 95-95-95 targets, South Africa is said to still be suffering from one of the largest HIV epidemics globally.
According to the World Health Organisation (WHO), HIV continues to be a major global public health issue, having claimed more than 35 million lives so far. It said in 2018, 770 000 people had died from HIV-related causes globally.