To become a prescriber of ARTs or PrEP, the clinician must apply to the Ministry of Health, specifying whether they intend to prescribe both or either type of medicine.
The clinician needs to demonstrate that they meet the criteria (usually by way of letter together with their CV), and arrange for a letter of support for their application from a colleague who is an approved prescriber of ARTs in New Zealand. The clinician's letter should address the competency and currency requirements specified below.
Once the Ministry receives the set of information from the applicant clinician, the Ministry forwards it to the Panel of HIV Specialists for assessment and advice on the application.
When the Panel advises the Ministry that the clinician fulfils the requirements defined by the Ministry for a clinician’s name to be included on the antiretroviral prescribing list, PHARMAC is informed that the clinician has been approved to prescribe HIV antiretroviral agents in New Zealand. PHARMAC sets its systems to recognise the new approved prescriber and notifies the clinician that they are now able to commence with ART prescribing.
Should the Panel have any queries or concerns, the Ministry would communicate accordingly with the applicant.
Criteria for approval to prescribe antiretroviral agents
Prescribing antiretroviral therapy to treat HIV infection is a specialist area that requires appropriate training, experience, and ongoing clinical practice. Accordingly, the Ministry of Health maintains a list of clinicians approved for prescribing antiretroviral therapy in New Zealand. This is consistent with best practice guidelines published by the Department of Health and Human Services in the United States of America (see the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV on the AIDSinfo website).
The Ministry obtains specialist advice on a case-by-case basis, from a panel of selected clinicians working in this area, on applications to become an approved prescriber of antiretroviral agents.
Criteria for being entered on to the list are the demonstration of competency, currency, and ongoing clinical and management of HIV infected persons. The following requirements need to be fulfilled for a clinician’s name to be included on the antiretroviral prescribing list.
- The clinician must hold an appropriate specialist qualification in internal medicine, paediatrics, or sexual health.
- The clinician should have received appropriate training in HIV medicine as part of their advanced training programme. For example, infectious disease physicians or sexual health physicians all undergo a substantive component of training with respect to HIV management as a core component of their advanced training programmes.
- The clinician should have experience of supervised management of HIV infection over a period of time, the general recommendation being that such care would normally involve at least 5–10 HIV infected persons over a period of at least 2–3 years.
- The clinician will have ongoing clinical responsibility for the management of HIV infected persons.
- The clinician needs to show evidence of belonging to a specialist society that has significant involvement with HIV medicine, or other avenues of clinical medicine that have particular responsibility for the management of HIV. Society specialisations such as infectious diseases, sexual health, paediatrics, obstetrics and gynaecology are suitable. Membership of the Australasian Society for HIV Medicine (ASHM) is also suitable.
- If the clinician has completed the Australian advanced training module for HIV prescribing, and has prescribing rights for Australia and shows evidence of ongoing educational training, then they can be considered for prescribing rights for antiretroviral agents in New Zealand.
- The clinician should be able to show evidence of attending regular clinical meetings where HIV has a significant component, such as attending infectious disease meetings, clinical microbiology meetings such as the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC meetings), Australasian Society of Infectious Diseases (ASID meetings) or attend specialist HIV meetings such as the ASHM Conference or the International AIDS Society (IAS) meetings.
- The clinician should be recognised and supported by local colleagues as having a particular interest and expertise in the management of HIV infections, and those colleagues should be prepared to propose the clinician for inclusion on to on the antiretroviral prescribing list.
- The publication of papers, posters or presentations attesting to the clinician’s involvement in the field of HIV medicine can also be presented for consideration, confirming the clinician’s clinical experience and involvement in the field of HIV medicine.
- The clinician should be able to provide evidence of being credentialed for the management of HIV infection in the institution where they currently work or are proposing to work.
- A clinician’s name on the antiretroviral prescribing list will be reviewed five-yearly by a process whereby a letter is sent to the individual asking them to confirm that they can provide evidence to the Ministry of their ongoing suitability to retain their inclusion on the antiretroviral prescribing list.