Pharmacy Act, 1974 (Act No. 53 of 1974)

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A Pharmacist who provides Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) services in South Africa: Scope of Practice, Competency Standards and the Criteria for Accreditation of a Pharmacist Initiated Management of Antiretroviral Therapy (PIMART) Course

Part 2: Competency Standards for a Pharmacist who provides Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) Services

Domain 2: Initiate Pre-Exposure Prophylasis (PrEP), Post-Exposure Prophylaxis (PEP) and 1st Line Antiretroviral Therapy (ART) plus initiation of TB-Preventative Therapy (TPT) where appropriate and apply protocol adherence measures
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INTRODUCTION

 

The domain covers competencies that are required to initiate therapy and apply protocol adherence measures. A concept adopted by NDoH which advocates that 90% of people who know their HIV status will receive treatment with at least 90% of those on treatment being virally suppressed.

 

The competencies required in the domain for testing and diagnosis of HIV are:

 

2.1 Demonstrate knowledge of ART Principles;
2.2 Prepare patients for ART adherence;
2.3 Identify, classify, and analyse the various types of ARTs and their side effects and toxicities;
2.4 Initiate ART;
2.5 Analyse ART medicine choices in PrEP and PEP, and considerations around pharmacology and drug interactions, including TPT;
2.6 Identify and manage PrEP, PEP and ART contra-indications; and
2.7 Conduct PEP in the PIMART environment.

 

DOMAIN 2: INITIATE PRE-EXPOSURE PROPHYLAXIS (PrEP), POST-EXPOSURE PROPHYLAXIS (PEP) AND 1ST LINE ANTIRETROVIRAL THERAPY (ART) PLUS INITIATION OF TB-PREVENTATIVE THERAPY (TPT) WHERE APPROPRIATE AND APPLY PROTOCOL ADHERENCE MEASURES

COMPETENCIES

BEHAVIOURAL STATEMENTS
2.1 Demonstrate knowledge of ART Principles
2.1.1 Describing the objectives of ART.
2.1.2 Describing the HIV life cycle, CD 4 counts, viral load and when to start therapy.
2.2 Prepare patients for ART adherence
2.2.1 Defining ART adherence.
2.2.2 Applying the pre-ART counselling process.
2.2.3 Prepare patients for ART by applying the adherence counselling process.
2.2.4 Interpreting viral load results and monitor for ART adherence.
2.2.5 Conducting laboratory monitoring for antiretroviral therapy efficacy and safety.
2.2.6 Applying the post-ART counselling process.
2.3 Identify, classify, and analyse the various types of ART and their side effects and toxicities
2.3.1 Demonstrating knowledge of the classes of ART.
2.3.2 Describing the pharmacology, dosing, side effects, toxicity monitoring and management of medicines used in 1st line ART, PrEP and PEP according to current national guidelines.
2.4 Initiate ART
2.4.1 Describing first-line treatment pharmacology practicalities in PIMART.
2.4.2 Identifying who is not eligible for therapy via PIMART by analysing initiation limitations in PIMART.

Range: TB, IRIS, cryptococcal meningitis, hepatitis B, pregnant woman, patients under 15 years.

2.4.3 Describing ART Initiation steps and implementing the ART initiation algorithm according to current national guidelines.
2.4.4 Transitioning a patient from PrEP to ART if required.
2.5 Analyse ART medicine choices in PrEP and PEP, and considerations around pharmacology and drug interactions, including TPT
2.5.1 Describing and analysing pharmacology, dosing, toxicity, side effects and drug interactions of various regimens as determined by NDoH for PEP and PrEP.
2.6 Identify and manage PrEP, PEP and ART contraindications
2.6.1Identifying PEP contraindications.
2.6.2 Analysing and classifying the management of ambiguities in source status, source ART adherence, and patient HIV status.
2.6.3 Referring pregnant and breastfeeding women who require PEP.
2.6.4 Describing Hepatitis B screening and vaccination as set out in the PHC EML for PEP.
2.7 Conduct PEP in the PIMART environment
2.7.1 Describing PEP in the PIMART Context.
2.7.2 Listing PEP Indications.
2.7.3 Identifying at-risk groups in terms of PEP.
2.7.4 Analysing PEP Efficacy.
2.7.5 Describing the steps in the PEP treatment process.
2.7.6 Initiate clients on PEP.
2.7.7 Implementing adherence monitoring and follow-up.
2.7.8 Implementing the PEP to PrEP transition.