Nokukhanya Mdlalose, a South African family practitioner, writes the GALEN Certification Examination during its June 9, 2005, administration in Durban, South Africa. (Photo: Jaz Hughes)

With those words published in the June 2000 issue of the IAPAC Monthly, the International Association of Physicians in AIDS Care (IAPAC) announced its first steps in the creation of a unique and much-needed credentialing process that will help improve the quality of health care provided to HIV-positive people in the developing world. We have traversed rocky terrain, overcome overwhelming challenges, and persevered through numerous setbacks to advance our commitment to the education of physicians in the provision of improved care for the millions who rely on overburdened and strained health care systems for their care and support.

I am proud to report this month that five years later, on the anniversary of my June 2000 announcement, nine South African physicians passed our GALEN Certification Examination with a score of 70% or higher, thus becoming the first HIV/AIDS-treating physicians in the world to be certified, however informally, in the field of HIV medicine.

IAPAC pursued this course of action for two very basic reasons: 1) our members identified certification as a priority; and 2) we believe that such a process will enhance and support the development of clinical care "best practices" in HIV medicine, leading to corresponding improvements in the health of HIV-affected communities.

Certification in the medical disciplines is viewed as a form of self-regulation that implies the development of standards. In the certification process, a certifying organization convenes a group of experts in a particular discipline to define standards of acceptable knowledge and/or performance, and to measure competence by means of those standards. Among several common attributes of certification programs are:

• incorporation of a formal, systematic, and highly structured process for standards development and review;

• voluntary enrollment, typically through a volunteer-driven process;

• involvement of some form of peer review, where groups of experts are called upon to determine acceptable levels of competence and/or performance;

• a primary goal of protecting the public or enhancing the quality of a service provided to the public; and

• establishment of clinical "best practices" through an expert consensus process.

GALEN builds upon all of these components. In the creation of GALEN, IAPAC acted on the certain knowledge that provision of suboptimal care for HIV-positive patients causes the development of antiretroviral drug resistance, as well as unnecessary morbidity and mortality. As antiretroviral therapy scaleup efforts bear results and allow for greater availability in resource-limited settings, the ability of health care professionals to optimally administer therapy is essential from multiple perspectives -- among them the humanitarian, economic, and clinical perspectives. The decision was made to offer a certification examination to physicians who would volunteer to write the examination based on their desire to provide care consistent with best practices in HIV medicine.

The GALEN Certification Committee is a panel of world-class HIV thought leaders from developed and developing countries that crafted the examination based on their combined knowledge of best practices in HIV/AIDS care delivery in resource-limited settings. The committee's parameter for acceptable performance on the 200-question examination was based on the high level of knowledge derived from the 13-module GALEN course in HIV medicine, which covers clinical management issues along a continuum of HIV/AIDS care -- from prevention to palliative care, with a heavy emphasis on antiretroviral therapy. Physicians who elect to write the examination test their knowledge against an HIV medicine knowledge base unsurpassed in the world. Those physicians who passed the examination during its inaugural administration in Durban, South Africa, can feel justifiably proud of their accomplishment; those who did not pass will have time to hone their skills and another opportunity in the future to demonstrate improvement.

GALEN would not be possible without the dedication and hard work of the GALEN Curriculum and Certification Committees as well as GALEN training module authors, whose talent and dedication have been an inspiration to all. In addition, various IAPAC staff members have spent innumerable hours and devoted their considerable skills in helping create a sustainable program unique in its ability to both improve and measure the skills of participating physicians.

I sincerely hope that IAPAC members share a sense of pride in the accomplishment of this important task. As GALEN continues to advance and improve, it does so only through the support of IAPAC's membership, whose volunteer time is invaluable, as well as through institutional support from various organizations, including the American International Health Alliance (AIHA) and the Pan American Health Organization (PAHO). As we look forward to new challenges, ever-present in our fight against the AIDS pandemic, we should allow ourselves a moment of satisfaction as we contemplate the achievement of this milestone.

José M. Zuniga is President/CEO of the International Association of Physicians in AIDS Care (IAPAC), and Editor-in-Chief of the IAPAC Monthly.