This research study has shown that dysphagia does occur in patients who are living with HIV/AIDS regardless of their co-morbid conditions, CD4 count, age and HAART regimen. It is therefore important that a SLP be involved in the assessment and management of these patients. However, it is also important that these patients need to be managed in a multidisciplinary team in order to improve patient management and their quality of life. Ideally, for a dysphagia assessment, both a subjective an objective test should be done. However, in developing countries it is not always possible for objective measures to be done. Therefore, this research has shown that the MASA can be performed as a bedside assessment because it will yield accurate results.
6.1. Limitations of the study
A random error can affect the reliability of the results of the study. Random error is considered to be random disturbances in the performance on the measure (Durrheim et. al, 2006). However, this was not evident in the Spearman Rho test that was performed. The pitfall of a cross-sectional research design is that it does not analyse the population over a longer period and therefore, the changes of the population cannot be observed (Rosnow & Rosenthal, 2002).This study managed to yield some important results. However, for future research, a longitudinal research design could possibly be used. Another limitation was that there were only 26 participants that underwent a modified barium swallow. This was due to difficulties with the hospital x-ray equipment. A small number of participants may not yield such reliable results as a larger sample size would yield.
6.2. Recommendations for future research
There needs to be more research conducted in the field of HIV/AIDS and dysphagia such as: The specific effects of the different co-morbid conditions on dysphagia as compared to individuals who are HIV negative. In regards to the longitudinal effects of HAART on dysphagia, there is a need to compare the effects that the different HAART regimens have on dysphagia in people who are living with HIV/AIDS. Research is needed to conduct more
dysphagia assessments utilising both subjective and objective measures. More research needs to be done which looks at multidisciplinary team studies in the area of HIV/AIDS and dysphagia. This should include quality of life assessments in the area of dysphagia and HIV/AIDS. The ethical management of dysphagia in HIV/AIDS populations is also important. Based on the limitations of the study, longitudinal research needs to be conducted to evaluate the long term effects of HIV/AIDS on dysphagia in adults.
6.3. Further recommendations
It is recommended that perhaps the speech therapists who are working in the government sector need to create increased awareness of the role of the speech therapist in dysphagia in general as well as in dysphagia within the HIV/AIDS population. The MDT members that should be targeted are: doctors, dieticians, physiotherapists and occupational therapists. This is important in order to increase the number of referrals that are sent to speech therapists thereby improving patient management. As patient management improves, their quality of life will improve.
Speech therapists should form part of the medical team that manage in and out patients who are living with HIV/AIDS. As this research study has concluded, the speech therapist has a vital role to play in the assessment and management of these patients.
The effects of HIV/AIDS should be taught to undergraduate students. If the students have a good understanding of how HIV/AIDS can affect an individual, this would improve patient management when the students are in their community service year.
Speech therapists should form part of the research team to assess the effects that HAART regimens have on a patient’s symptoms. South Africa has the largest population of people who are infected with the HI virus and therefore it is important that research be conducted in this environment.
6.4. Implications
This research has therefore yielded important clinical results for the SLP practicing in South Africa. Dysphagia does occur in participants who are living with HIV/AIDS regardless of co- morbid conditions, CD4 count, age and HAART regimen. The MASA (Mann, 2002) is a time effective and accurate bedside assessment tool for dysphagia and therefore it can be used in rural areas and in clinical settings where objective measures are unavailable. The SLP needs to be involved in the assessment and management of these patients in order to improve their quality of life. This study has also highlighted the importance of conducting future research in this area.
6.5. Conclusion
As stated previously, HIV/AIDS has become the world’s most serious public health problem (UNAIDS, 2009). South Africa has the highest HIV/AIDS population in the world. Therefore it is important that these studies be conducted in South Africa because SLP’s will be faced with these conditions as part of their everyday management. Based on the literature that was reviewed for this study, it can be seen that dysphagia is prevalent in this population. However, insufficient studies have been conducted that specifically assess dysphagia. The results from this study have concluded that dysphagia is present in this population irrespective of co-morbid conditions, CD4 count, HAART regimen and age. It is therefore of great importance that the SLP in South Africa be involved in the multidisciplinary management of these patients in order to improve their quality of life. The Mann Assessment of Swallowing Ability (MASA) (Mann, 2002) is a reliable assessment tool that the SLP in South Africa can utilise to assess dysphagia in their acute adult patients. As shown in this study, the area of HIV/AIDS is a significant topic for healthcare in South Africa and it is therefore vital that more research be conducted in order to improve our knowledge of how best to treat these patients.