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CMSA

T h e Col l eges of Medi ci n e of Sout h Afr i ca NPC


No n p ro fit C o m p an y (R eg. No . 1955/ 000003/ 08)
No n p ro fit Organ is at io n (R eg No 009-874 NP O)
Vat Number: 4210273191

2 7 R h o d e s Av e , P AR KT O W N W E S T 2 1 9 3
P r i v a t e B a g X2 3 , B R AAM F O N T E I N 2 0 1 7
T e l : + 2 7 1 1 7 2 6 -7 0 3 7 / 8 / 9
F a x : + 2 7 1 1 7 2 6 -4 0 3 6
General:
a d mi n @ c msa -j h b . c o . z a
Ac a d e mi c R e g i st r a r :

JOHANNESBURG

a l v @ c msa -j h b . c o . z a

W e b si t e :

www. c o l l e g e me d sa . a c . z a

ACADEMIC OFFICE
August 2016

FOR ADMISSION TO THE DIPLOMA IN HIV MANAGEMENT OF


THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Dip HIV Man(SA)


1.0

SCOPE AND OBJECTIVES / ADMISSION TO THE EXAMINATION

1.1

The purpose of the Diploma in HIV management is to encourage postgraduate training in the field of
HIV management and to improve the standards of medical practise and patient care in rural and urban
communities outside the larger training centres. It is aimed primarily at doctors who wish to improve their
basic clinical skills and competence in the diagnosis and management of HIV/AIDS

1.2

The Diploma is intended for people from all disciplines within medicine

2.0

QUALIFICATION

2.1

In order to qualify to write the examination the applicant must be registered or registrable with the
Health Professions Council of South Africa

2.2

Foreign graduates whose qualifications are recognised by the Health Professions Council of South Africa are
encouraged to write the examination

2.3

If recently qualified, the applicant may write during their community service year if they have completed the
required training

2.4

Education and Training


Currently the candidates will be required to manage their own training, however, a number of training
initiatives are in development and these should be updated on a routine basis. These training initiatives are
independent of the CMSA and therefore the CMSA cannot be held responsible for the quality of these
training programs

3.0

ADMISSION TO THE EXAMINATION


(to be read in conjunction with the Instructions)

3.1

Qualification
3.1.1 The candidate must for two years have held a qualification to practise medicine which is registered
or registrable with the Health Professions Council of South Africa
3.1.2 The CMSA Senate, through its Examinations and Credentials Committee, will review all
applications for admission to the examination and may also review the professional and ethical
standing of candidates

3.2/

Dip HIV Man(SA)


3.2

PAGE 2

Education and Training


Within the seven years preceding the examination, the candidate will have to accumulate 1000 credit points
in the following 3 categories:
3.2.1

3.2.2

3.2.3

Supervised training
3.2.1.1
Certified post-internship fulltime, or sessional supervised training in an HIV unit at a
teaching or CMSA-approved hospital at a rate of 1 credit point per hour, to a maximum
of 170 points per continuous month (6 months fulltime is sufficient)
Unsupervised experience
3.2.2.1
Fulltime general/primary care/non-specialist practise or experience in non-CMSAapproved hospitals which embrace aspects of HIV care at the rate of 250 points per
annum, or 20 points per continuous month
3.2.2.2
Part-time general/primary care/non-specialist practise or experience in non-CMSAapproved hospitals which embrace aspects of HIV care at a rate of 0.125 point per hour,
provided that no credit will be granted for part-time practise of less than 45 hours per
continuous month
3.2.2.3
Unsupervised experience will attract a maximum of 800 credit points, which must be
claimed by a letter from the candidates HOD.
3.2.2.4
Credit points claimed in terms of 3.2.2 (Unsupervised experience) will be awarded only if
claimed in conjunction with a minimum of 200 credit points awarded under 3.2.3
(Theoretical education/training)
Theoretical education/training
3.2.3.1
Credit points in sections 3.2.3.1.1 to 3.2.3.1.4 will be awarded at the rate of 5 points per
hour, certified by either the presenter or the organiser of the ward round, course,
conference, congress, lecture, or symposium, and declared as correct by the candidate
3.2.3.1.1
Teaching ward rounds, mortality/morbidity meetings, patient presentations
in HIV care at a recognised hospital
3.2.3.1.2
Formal courses, congresses or conferences in HIV care
3.2.3.1.3
Formal lectures or symposia in HIV care
3.2.3.1.4
Formal consultations in HIV care with a registered specialist
3.2.3.1.5
Relevant research publications in reputable journals
3.2.3.2
In section 3.2.3.1.5 credit may be awarded to a maximum of 100 points at 50 points per
acceptable publication. The decision of the CMSA with regard to acceptability of
publications offered will be final

4.0

LABORATORY CRITERIA
EXAMINATION

FOR

ELIGIBILITY

TO

ENTER

ABOVE

DIPLOMA

4.1

Registered pathologists in any branch of pathology who deal with specimens, reports or consultations in
respect of HIV-infected patients or HIV contacts

4.2

Registrars in pathology who have completed 4 years of post-registration practise or a minimum of 2 years of
pathology training

4.3

Medical practitioners in other categories with laboratory experience will be evaluated on an individual basis

5.0

SYLLABUS OF THE EXAMINATION

5.1

The syllabus provides the candidate with the knowledge necessary to adequately diagnose and manage
HIV/AIDS (Appendix A). Please note that this syllabus is a guideline and other items may be included in
the examination

6.0/

Dip HIV Man(SA)

PAGE 3

6.0

CONDUCT OF THE EXAMINATION

6.1

Examinations will be held twice a year in centres approved by the CMSA. While applicants of all
disciplines are permitted to write the examination, questions will be multi-disciplinary

6.2

Written Examination
The examination will consist of two papers, three hours each, one with multiple choice questions/OSCE and
one with short essay-type questions
6.2.1
Candidates must obtain a subminimum of 45% for each paper
6.2.2
Candidates must obtain an overall average of 50% to pass the examination

6.3

Weighting
MCQ
OSCE
Short Essays

JOHANNESBURG
August 2016

25%
25%
50%

Dip HIV Man(SA)

PAGE 4

7.0

ADMISSION AS A DIPLOMATE

7.1

The candidate having passed the examination and having been admitted as a Diplomate of the CMSA,
will be asked to sign a declaration, as under:
I, the undersigned, do solemnly and sincerely
declare
that while a member of the CMSA I will at all times do all within my power to promote the objects of the
CMSA and uphold the dignity of the CMSA and its members
that I will observe the provisions of the Memorandum and Articles of Association, By-laws, Regulations and
Code of Ethics of the CMSA as in force from time to time
that I will obey every lawful summons issued by order of the Senate of the said CMSA, having no
reasonable excuse to the contrary
and I make this solemn declaration faithfully promising to adhere to its terms
Signed at .............. this day of
.. 20 ..
Signature
Witness
(who must be a Founder, Associate Founder, Fellow, Member, Diplomate or Commissioner of Oaths)

7.2

A two-thirds majority of members of the CMSA Senate present at the relevant meeting shall be necessary for
the award to any candidate of a Diploma

7.3

A Diplomate shall be entitled to the appropriate form of certificate under the seal of the CMSA

7.4

In the event of a candidate not being awarded the Diploma (after having passed the examination) the
examination fee shall be refunded in full

7.5

The first annual subscription is due one year after registration (statements are rendered annually)

JOHANNESBURG
August 2016

Dip HIV Man(SA)

PAGE 5

APPENDIX A
CURRICULUM FOR THE DIPLOMA IN HIV MANAGEMENT(SA)
1.0

HISTORY AND EPIDEMIOLOGY OF HIV/AIDS


History of the epidemic
Global epidemiology
Southern African epidemiology
Controversies around the epidemic
Theory of the origin of AIDS

1.1

Impact
Demographic survey techniques Pros and Cons
Comparing Data and Statistics
Different statistical trends eg mortality, morbidity etc
Factors influencing prevalence and trends
Impact of HIV incidence in different risk populations
OIs in different settings
Risk assumptions based on epidemiological patterns

2.0

ETHICAL CONSIDERATIONS
Pre and post-test counselling
Confidentiality vs duty to warn
Ethics of clinical trials
Access to therapy
Community ethics
Ethical issues specific to paediatrics
Vaccine studies
Vertical Transmission
Individual vs community good
International standards
Voluntary testing and counselling as point of entry to care
Notification issues
The role of the state, the Health Professions Council of South Africa, doctors as individuals, and civil
society, in providing access to care
Access to care for foreign patients
Workplace and legal issues
Practical resources eg: university ethics boards, local ethicists contact details, Aids Law Project, legal
advice centres, human rights commission

3.0

LABORATORY TESTING
Antibody testing methodology including an understanding of specificity and sensitivity of the various
tests:
ELISA
Western Blot
Rapid Tests
WHO and local guidelines for testing
P24 assays

Molecular testing in diagnosis and management


PCR Qualitative and Quantitative
HIV viral load CD4/CD8
Antiretroviral and resistance testing
Donor blood and organ testing

4.0/

Dip HIV Man(SA)

PAGE 6

4.0

CONCEPTS OF PREVENTION
Behavioural modification issues and education
Promotion of barrier methods etc
Issues specific to women
Issues of primary and secondary prophylaxis of OIs
STI treatment
HAART as secondary prevention/intervention
Post exposure prophylaxis

5.0

MECHANISM AND RISK OF TRANSMISSION


Risk of transmission for various encounters
Various Sexual practices
Bite wounds
Needle stick
Blood transfusion
Vertical Transmission
Co-factors increasing risk

6.0

PATHOGENESIS AND NATURAL HISTORY OF HIV DISEASE


Virology of HIV
Including Subtypes and quasispecies, intersubtype recombination and genetic diversity
Dynamics of viral replication
Including concept of viral reservoirs and co-receptors
Interaction with the immune system
Adult vs Paediatric
Clinical correlates at various stages
Significance of viral reservoirs
Development of resistance
Mechanism of action of various drugs

7.0

PRINCIPLES OF HAART
Theory and rationale for viral suppression
Importance of antiretroviral adherence
Indications, including critical appraisal of the rationale behind different current strategies
(national and international guidelines) for both adult and paediatric patients
Contra-indications, toxicities
Treatment planning and initiation options
Drug interactions
Different antiretroviral drugs and drug classes
TB treatment/prophylaxis and other OI treatments/prophylaxis
Management of drug toxicities
Immune reconstitution syndrome
Impact of HAART on OI management
Management of antiretroviral resistance
Options for treatment failure
Current constraints and costs, emerging resources
Practical resources in terms of getting advice

8.0/

Dip HIV Man(SA)

PAGE 7

8.0

CONTINUUM OF CARE
Staging of patient
Holistic approach
Levels of care interventions
Evidence based vs best practices
Care provision team
Care settings home vs community
Care support activities
Peer counselling groups
Community based groups
Palliative strategies for common clinical problems eg pain, dementia, psychosis, weakness, diarrhoea,
pruritis, breathlessness etc

9.0

VERTICAL TRANSMISSION
Rates global vs SA
Factors that influence risk
Role of breastfeeding and current recommendations
ART to reduce transmission
Infant diagnosis
Ethical and Public health issues

10.0

COMPLICATIONS OF HIV INFECTION, TREATMENT AND PROPHYLAXIS


Prevalence of OIs locally, regionally and internationally
Local and international guidelines for OI prophylaxis
Spectrum of OIs at the different stages of HIV
Pathogenesis of OIs, clinical presentation and treatment
Seroconversion
STDs and HIV
Oncology of HIV
Immunological disorders in HIV (includes drug reactions, non-infective rashes, etc)
Heralding OIs (infections indicative of HIV infection)
Clinical staging (WHO 1-4 or CDC A, B and C conditions)
Tuberculosis epidemiological overview, microbiology, clinical presentation, diagnostic procedures,
laboratory techniques of diagnosis (including in resource poor-settings), local guidelines for TB control
Systematic approach to disease systems:
Respiratory
Skin
Nervous System
Gastro-intestinal
ENT
Uro-genital
Ocular
Renal
Cardiac
Rheumatological
Endocrine
Paediatrics specific issues
Reticulo-endothelial system

11.0

NEW DEVELOPMENTS IN HIV MANAGEMENT


Immunology and immune therapies
Vaccine developments
New drugs and drug targets

JOHANNESBURG
August 2016

Dip HIV Man(SA)


12.0

RECOMMENDED READING/RESOURCES

1.

Primary Aids Care recent addition


Authors:
Clive Evian
Publisher:
Jacana Education

2.

Medical Management of HIV infection, recent addition


Authors:
JG Bartlett and JE Gallant
Publisher:
Johns Hopkins University School of Medicine
(* this book is updated on a yearly basis)

3.

Handbook of HIV Medicine


Authors:
D Wilson, S Naidoo, IG Bekker, M Cotton, G Maartens
Publishers:
OUP Southern Africa

4.

The clinical practice of HIV medicine


Author: David Spencer
Publisher:
Goldstream books

13.0

RECOMMENDED WEBSITES
http://www.unaids.org/en/
http://www.sahivclinicianssociety.org
http://www.iapac.org
http://www.hopkins-aids.edu

NB:

These are just a few of the possible resources available and are by no means comprehensive

JOHANNESBURG
August 2016

PAGE 8

Dip HIV Man(SA)

PAGE 9

CMSA-RECOGNISED HOSPITALS FOR DIP HIV MAN(SA) TRAINING


Candidates are informed that training in fulfilment of the Dip HIV Man(SA) examination regulations may be
undertaken in:
Bethesda Hospital
Brewels Kloof Hospital
Eshowe District Hospital
George Regional Hospital
Helderberg Hospital, Somerset West
Hlabisa Hospital
Leratong Hospital; Krugersdorp
Lower Umfolozi District War Memorial Hospital
Mseleni Hospital
Murchison Hospital
Paarl Hospital
Partners in Health Lesotho
St Chads Community Health Centre
Zithulele Hospital

JOHANNESBURG
August 2016