Access to TB prevention treatment and antiretroviral (ARV) medication is about to get easier in South Africa. People will soon be able to get a range of HIV services from pharmacists with special training. 

South Africa’s HIV treatment programme is already the largest in the world with around six million people on antiretroviral therapy (ART). Close to eight million people in the country have HIV. This means two million more are not receiving treatment. Pharmacy-Initiated Management of Antiretroviral Treatment (PIMART) aims to expand access to HIV treatment. 

Vincent Tlala is the Registrar and CEO of the South African Pharmacy Council (SAPC). He explains that PIMART was first approved in August 2021. To date, 900 pharmacists have ben trained to provide PIMART services. But the programme was put on hold after a doctors’ organisation, the Independent Practitioners Association Foundation, went to court to halt the implementation of the initiative. In the court application the doctors raised numerous concerns, such as allowing pharmacists to prescribe ARVs would impinge on the territory of medical practitioners.

But a recent ruling by the Gauteng High Court in Pretoria dismissed the doctors’ application – essentially allowing PIMART to proceed. 

Before this initiative only nurses and doctors could prescribe ARVs. Nurse-initiated and managed antiretroviral treatment was introduced in 2010. Under PIMART accredited pharmacists will be able to prescribe TB preventive treatment. Pharmacists will also be able to test people for HIV and prescribe first line ART.  In addition, pharmacists with the necessary accreditation will be able to give people both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) drugs  to help prevent HIV infection. 

Key to reaching global targets

Countries around the world have committed to ending HIV as a public health threat by 2030. The aim is to do this by reaching the United Nations’ 95-95-95 targets. The goals are to have 95% of all people with HIV know their status; 95% of people with HIV on treatment; and 95% of people on treatment to be virally suppressed by 2025.

South Africa is just shy of these targets. 

“Figures show that 94% of persons living with HIV know their status and only 77% of these are on treatment.This means that almost 22% of persons living with HIV are without any sort of care,” says the SAPC’s Tlala. 

He says that this is because of a number of factors including not having enough healthcare workers to initiate treatment as well as having limited treatment points across the country. 

Bridging the gap

Reshma Ramnandan, pharmacy supervisor at AIDS Healthcare Foundation, a global nonprofit that provides HIV services, says the overall public health experience in South Africa is still a major barrier to people starting and staying on ARVs. 

Ramnandan says public health facilities have become much more open over the years. But some communities still struggle to access public health facilities in South Africa. In addition, research found that not being able to get to a clinic for set appointments was one of three major reasons that patients interrupted treatment. 

“PIMART is also a tool to address the lack of adherence to treatment by people with HIV, and the high number of avoidable AIDS-related deaths, by allowing them access to ARVs through trained pharmacists,” she says. 

Also, Ramnandan says that PIMART will help improve access to ART in rural communities and communities where public health facilities are geographically spread out and difficult to access.

Key populations 

South African National AIDS Council (SANAC) spokesperson Nelson Dlamini hopes that people who are most vulnerable to HIV acquisition would benefit from the expanded access to care. Key population groups include gay men and men who have sex with men, sex workers, transgender people, people who inject drugs and incarcerated people. 

Dlamini says he is concerned transgender women continue to face issues in various pockets of the country where sensitisation hasn’t properly penetrated the healthcare space.

“Various studies have indicated that transgender women are less likely to seek care due to stigma from healthcare staff and other people who have come to seek care at the facility. This means, sensitisation must go beyond just the healthcare facility staff but in communities as well.” 

A report published by community monitoring group, Ritshidze earlier this year found that there has been little change in the crisis that sees key populations continue to be ridiculed, abused and even chased away from clinics while seeking healthcare services.

Dlamini says, by giving people more options of where to access care, PIMART is going to be a gamechanger for people living with HIV as well as those who need access to HIV prevention tools such as PrEP and PEP. – Health-e News