CMSA

The Colleges of Medicine of South Africa NPC

Nonprofit Company (Reg No.1955/000003/08)
Nonprofit Organisation (Reg. No. 009-874 NPO)
Vat No. 4210273191

27 Rhodes Avenue, PARKTOWN WEST, 2193

Tel: +27 11 726 7037; Fax: +27 11 726 4036

Website: www.cmsa.co.za
JOHANNESBURG OFFICE General:
Academic.Registrar@cmsa.co.za

EXAMINATIONS & CREDENTIALS

October 2019
R E G U L A T I O N S
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) PAGE 2
3.2 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 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)
3.2.1.2 A letter that demonstrates that candidates work with patients who are HIV infected
under the supervision of a trainer who has a Cert ID (SA) or Dip HIV Man (SA) and
can motivate that appropriate exposure has been achieved, with a minimum of 6 months
full time
3.2.2 Unsupervised experience
3.2.2.1 Fulltime general/primary care/non-specialist practise or experience in non-CMSA-
approved 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-CMSA-
approved 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)
3.2.3 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 FOR ELIGIBILITY TO ENTER ABOVE DIPLOMA

EXAMINATION

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 EXAMINATION1

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, two hours each, one with multiple choice questions and one
will be an OSCE.
6.2.1 Candidates must obtain a subminimum of 50% for each paper
6.2.2 Candidates must obtain an overall average of 60% to pass the examination

6.3 Weighting
MCQ 50%
OSCE 50%

JOHANNESBURG
October 2019

1 Conduct of the examination effective SS 2020

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
October 2019
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 – Pro’s and Con’s
• Comparing Data and Statistics
• Different statistical trends eg mortality, morbidity etc
• Factors influencing prevalence and trends
• Impact of HIV incidence in different risk populations
• OI’s 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 OI’s
• 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 OI’s locally, regionally and internationally
• Local and international guidelines for OI prophylaxis
• Spectrum of OI’s at the different stages of HIV
• Pathogenesis of OI’s, clinical presentation and treatment
• Seroconversion
• STD’s and HIV
• Oncology of HIV
• Immunological disorders in HIV (includes drug reactions, non-infective rashes, etc)
• Heralding OI’s (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
October 2019
Dip HIV Man(SA) PAGE 8
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
October 2019