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ENHANCE-(Electronic Hydroxyurea Adherence): A Protocol to Increase Hydroxyurea Adherence in Patients with Sickle Cell

Susan Creary1, Deena J Chisolm, Sarah H O'Brien

  • 1Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, OH, United States. susan.creary@nationwidechildrens.org.

JMIR Research Protocols
|October 5, 2016
PubMed

Insights

Mobile Directly Observed Therapy (Mobile DOT) is an intervention to improve hydroxyurea (HU) adherence in children with sickle cell disease (SCD). This study evaluates Mobile DOT

Area of Science:

  • Pediatric Hematology
  • Chronic Disease Management
  • Digital Health Interventions

Background:

  • Hydroxyurea (HU) is the primary disease-modifying therapy for sickle cell disease (SCD), yet suboptimal adherence limits its effectiveness in pediatric patients.
  • Adherence rates to HU in children with SCD range from 35% to 50%, highlighting a critical need for improved management strategies.
  • Mobile Directly Observed Therapy (Mobile DOT) is an innovative, multidimensional intervention designed to address adherence challenges by integrating technology and behavioral science.

Purpose of the Study:

  • To assess the impact of the Mobile DOT intervention on hydroxyurea (HU) adherence in pediatric patients diagnosed with sickle cell disease (SCD).
  • To provide data that can inform the development of future adherence interventions and refine pediatric SCD treatment protocols.

Main Methods:

  • A single-arm crossover study design was employed, involving pediatric patients with SCD.
  • Participants engaged in a 6-month Mobile DOT phase, utilizing video self-recording of HU intake, text message reminders, adherence feedback, and incentives.
  • HU adherence during the Mobile DOT phase was compared against baseline adherence (6 months pre-intervention) and post-intervention adherence (6 months post-Mobile DOT).
  • Medication possession ratio served as the primary outcome measure for HU adherence.

Main Results:

  • The clinical trial is currently in progress.
  • Preliminary participant feedback indicates high satisfaction with the Mobile DOT intervention.
  • Participants reported that daily engagement with Mobile DOT requires less than five minutes.

Conclusions:

  • The Mobile DOT strategy shows promise for enhancing HU adherence in pediatric SCD patients.
  • Successful implementation of Mobile DOT could lead to improved clinical outcomes for patients with SCD.
  • Increased HU adherence through Mobile DOT may contribute to a reduction in healthcare costs associated with SCD management.
Abstract

Keywords:
adherence interventionchildrenhydroxyureasickle cell disease

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