Pharmacist-initiated antiretroviral therapy (PIMART)

Abstract

Pharmacist-initiated management of antiretroviral therapy (PIMART)To the Editor: We the undersigned, a collective of pharmacy researchers, practitioners and academics, call on the Minister to consider the following points in response to the input made by the South African Medical Association (SAMA) in relation to pharmacistinitiated management of antiretroviral therapy (PIMART), dated 9 September 2021. We wish to highlight the expertise of pharmacists in all matters relating to the design, production and use of quality, safe and affordable medicines. Furthermore, we need to stress the increasing importance of and role played by pharmacists in primary care teams, which has been further reinforced during the COVID-19 pandemic and subsequent vaccination efforts.Sub-Saharan Africa remains the region worst affected by the HIV epidemic, accounting for more than two-thirds of the global HIV burden. South Africa (SA) bears the largest HIV burden in the region, with nearly eight million individuals living with HIV; over four and a half million of these were receiving antiretroviral therapy (ART) in 2019. There have been substantial gains in recent years, with expansion of ART eligibility and adoption of the World Health Organization (WHO)-recommended universal test and treat (UTT) policy. However, many health systems across sub-Saharan Africa remain weak, under-resourced and overburdened. [1] Many countries in the region have yet to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 HIV targets and are therefore at risk of missing the 95-95-95 targets by 2030. In SA, an additional three million individuals need to initiate ART to reach the target of 95% of those diagnosed receiving ART by 2030. In particular, certain key populations that have not been reached by existing health services need to be prioritised.In a perfect world, every patient with HIV would be treated by an adult or paediatric infectious disease specialist, and prescribed an individualised regimen based on pretreatment genotyping. However, to impose that standard of care in resource-constrained settings would result in compromised access to care for many patients, and a net loss in health benefits. As a result, the WHO has advocated for a public health approach to HIV care, based on standardised regimens and with maximal reliance on task-shifting. [2] A demedicalised approach has been proposed for HIV prevention, including the provision of pre-exposure prophylaxis (PrEP). [3] SA adopted the UTT strategy in 2016 and the ART same-day initiation (SDI) policy in 2017. While the UTT policy removes clinical barriers to ART initiation, the SDI policy aims to reduce the time from HIV diagnosis to ART start to one visit. The SDI policy makes ART initiation logistically easier for patients and can further reduce patient losses in the pre-ART phase of care. However, in SA and other low-to middle-income countries, implementation of the UTT and SDI policies was not accompanied by expanded human resources or infrastructural capacity. SA has insuffici...

“Emotional stress is more detrimental than the virus itself”: A qualitative study to understand HIV testing and pre‐exposure prophylaxis (PrEP) use among internal migrant men in South Africa

“…This finding is consistent with other studies in sub-Saharan Africa, which have shown that pharmacies are perceived as more convenient, more private and less stigmatizing than clinics, particularly by men [73][74][75]. Thus, our study supports the important role of community pharmacies in differentiated HIV care delivery for men in South Africa [76,77] and in sub-Saharan Africa more broadly [75,78,79].…”

Stand‐alone model for delivery of oral HIV pre‐exposure prophylaxis in Kenya: a single‐arm, prospective pilot evaluation

“…One mechanism used in the United States is a collaborative practice agreement, which enables pharmacy providers to initiate, adjust and discontinue specified prescription drugs under the remote supervision of a clinician [ 54 ]. Alternatively, formalized training curriculums could be developed to certify interested pharmacy providers in PrEP delivery, like the Pharmacy Initiated Management of Antiretroviral Treatment course in South Africa [ 21 , 55 ]. New public–private partnership frameworks should also be considered to support the delivery of donated public antiretroviral medications [ 56 ] in private settings.…”

“…To reach populations that do not commonly seek health services in the public sector, Kenya's National AIDS & STI Control Program (NASCOP) called for evidence on the effectiveness and safety of PrEP delivery at private pharmacies. In collaboration with Kenyan stakeholders, a model of pharmacy‐delivered PrEP services was developed to implement for research purposes [ 10 , 20 ]—one of the first of its kind in Africa [ 21 ]. This model was adapted from a model ongoing in the United States (Seattle, Washington) [ 22 ]; details of the design process are published elsewhere [ 23 ].…”

Planning for decentralized, simplified prEP: Learnings from potential end users in Ga-Rankuwa, gauteng, South Africa

“…Studies have shown that it is feasible to use pharmacies to dispense ART and other chronic medication (62)(63)(64), with a study in Nigeria finding a higher ART continuity rate and viral load suppression in people who utilized pharmacies for refills compared to healthcare facilities (62). There has also been a proposal in South Africa for Pharmacy Initiated ART (PIMART), which will also include PrEP initiations (65). Previous studies the United States of America (United States) and Sub-Saharan Africa also found that actual and potential clients where in support of pharmacy PrEP distribution (66)(67)(68)(69).…”