South Africa: Courts to Decide Whether Pharmacists Can Start HIV Medicines Without a Doctor’s Script

In August 2021, the South African Pharmacy Council (SAPC) published legislation in the Government Gazette to enable pharmacists to prescribe and dispense antiretroviral medicines (ART) for the treatment and prevention of HIV. The initiative, known as Pharmacist-Initiated Management of ART, or PIMART, aims to address the low rates of uptake of ART prophylactic treatment in South Africa and close the gap between the numbers of people diagnosed with HIV and those initiated onto treatment. (At the time Spotlight reported on PIMART here.)

Yet, almost two years after the legislation was published, pharmacists remain unable to initiate ART in South Africa. This is because a legal challenge has been brought against the PIMART legislation and its introduction by the Independent Practitioners Association (IPA) Foundation.

The SAPC wrote in the December 2022 issue of its online Pharmaciae publication, “All processes relating to Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) are currently on hold, pending the outcomes of a court case.”

The IPA Foundation, which represents a group of private GPs in South Africa, filed a Notice of Motion with the Gauteng Division of the High Court in February 2022, requesting that the court stops the implementation of PIMART by setting aside the SAPC’s decision to implement PIMART and the legislation (Board Notice 101 of 2021) providing for its implementation.

The case brought by the IPA Foundation challenges the SAPC’s legislative mandate to implement PIMART, the need for PIMART, and the adequacy of the reasons put forward by the SAPC for the intervention. The IPA Foundation also asserts that the procedures by which the SAPC engaged stakeholders on PIMART’s legislation did not meet legally required standards. Finally, the IPA Foundation claims that pharmacists do not have the required expertise to initiate ART and that PIMART’s implementation will endanger patients.

In response to the arguments put forward by the IPA Foundation, the SAPC has filed a responding affidavit with the courts rejecting the IPA Foundation’s claims. The SAPC’s affidavit outlines the legislative powers held by SAPC, the need and reasons for PIMART, and the competency of pharmacists to initiate ART with supplementary training that is required under the PIMART programme. The SAPC further provides detail in its affidavit on the stakeholder engagements that were undertaken in designing PIMART’s legislation and supplementary training curriculum and argues that its procedures met all legal requirements for stakeholder engagement.

The hearing is scheduled to take place in the Gauteng Division of the High Court on Tuesday 23 May. The court’s ruling in this case is likely to have broad ramifications for how HIV treatment and prevention services are provided in South Africa.