The High Court in Pretoria has given the nod for the go-ahead to allow pharmacists to dispense first-line antiretroviral medicine to patients.
The court this week dismissed an application by the IPA Foundation to review and set aside the South African Pharmacy Council decision to implement its Pharmacist-Initiated Management of Antiretroviral Treatment.
The foundation claimed that the SA Pharmacy Council failed to provide interested parties with adequate opportunity to give comment or make representations before treatment was implemented.
The IPA contended that by adopting the treatment, the SA Pharmacy Council unjustifiably and irrationally extended the scope of practice of a pharmacist to encroach on the domain of medical practitioners.
It also argued the extension was irreconcilable and in conflict with legislation, and not authorised by the empowering legislative framework.
The IPA also said that the SA Pharmacy Council misled the Department of Health when it informed it that there was extensive consultation with stakeholders in developing the treatment. This, the IPA said, led the department to approve issuing permits for treatment services to be rendered.
The SA Pharmacy Council, in turn, asked that the application be dismissed. It submitted that the decision to introduce treatment to pharmacists’ scope of practice was rational and reasonable, particularly if regard was had to the narrow scope thereof.
Pharmacy-provided primary health care was a well-known and functional concept in South Africa and manifests in pharmacist-initiated therapy, and primary care drug therapy. The therapies are catered for in the existing legislative framework.
The accreditation and standard of the professional training that pharmacists require to enable them to provide the therapies, respectively, are regulated by the Pharmacy Act.
The court was told to provide primary care drug therapy, pharmacists must be authorised to prescribe Schedule 4 medication, and the provisions of the Medicines and Related Substances Control are used for obtaining permits. These permits authorise, suitably qualified pharmacists to prescribe specific medication for prescribed conditions, something they would not otherwise have been able to do.
Pharmacists qualified to provide primary care drug therapy can, among others, provide “Occupational Post Exposure HIV Prophylaxis for Health Care Workers”. PIT services already provided by pharmacists include HIV testing, emergency post-coital contraception, pregnancy testing, urine test analysis and patient wellness regarding sexual health.
Judge Elmarie van der Schyff, in dismissing the review application, noted that the therapies already empower pharmacists to consult, diagnose and manage patients.
The SA Pharmacy Council argued that IPA was wrong in perceiving the treatment to constitute an encroachment on the domain of medical practitioners, and stated that it was a measure within the ambit and control of the SA Pharmacy Council that falls under its mandate.
The council’s case was that the introduction of the treatment was not an extension of the scope of pharmacists’ practice by introducing a novel facet to it, but the widening thereof by the incorporation of a specific category of therapies in a system that already provides for these services for prescribed conditions.
Judge Van der Schyff said that although the SA Pharmacy Council did not provide the IPA with the reasons for its decision to implement the treatment, it had dispelled suspicions that the decision to implement the treatment was taken arbitrarily or capriciously.
“The untapped value of pharmacists in fighting HIV was emphasised by the efficient role pharmacies played in meeting health-care needs and providing health-care services during the Covid-19 pandemic.
“The idea to implement the treatment initiative is not a mere whim, it is consistent with the World Health Organization’s vision and a worldwide movement to promote widely accessible primary health care.
“It does not make logical sense on any level that a female can receive emergency contraception from a pharmacy within 72 hours after having intercourse, consensually or otherwise, but not simultaneously be provided with potentially life-saving Post-exposure prophylaxis, while a health worker who was exposed to HIV during the course of his or her employment, can be provided with post-exposure prophylaxis at a pharmacy,” the judge said.
According to her the treatment initiative gave the public a choice to either obtain their medication from a pharmacist who has the approved permit to issue it, or to consult a doctor.