A Multidimensional Electronic Hydroxyurea Adherence Intervention for Children With Sickle Cell Disease: Single-Arm...

Area of Science:

• Pediatric Hematology
• Digital Health Interventions
• Chronic Disease Management

Background:

• Hydroxyurea is a crucial disease-modifying medication for sickle cell disease (SCD).
• Nonadherence to hydroxyurea is common in clinical practice, leading to poorer health outcomes.
• Mobile Directly Observed Therapy (Mobile DOT) is an electronic intervention designed to improve hydroxyurea adherence in children with SCD.

Purpose of the Study:

• To evaluate the efficacy of the Mobile DOT intervention in increasing hydroxyurea adherence among pediatric patients with SCD.
• To assess the impact of Mobile DOT on key hematologic and clinical outcomes in children with SCD.

Main Methods:

• A 6-month, single-arm intervention study involving pediatric patients (≤19 years) with SCD on hydroxyurea and access to electronic devices.
• Hydroxyurea adherence was measured by the medication possession ratio (MPR), comparing periods with and without Mobile DOT.
• Hematologic and clinical outcomes were extracted from electronic medical records.

Main Results:

• Engaged participants (34/55) showed a significant increase in median MPR from 61.7% to 84.4% with Mobile DOT (P<.001).
• The proportion of participants achieving ≥80% adherence more than doubled (30% to 67%, P=.002).
• Significant improvements in mean fetal hemoglobin (HgbF) and mean corpuscular volume (MCV) were observed during the intervention but returned to baseline post-intervention.

Conclusions:

• Mobile DOT demonstrates potential as an effective adherence intervention for some children with SCD.
• Modifications are needed to enhance recruitment, reduce attrition, and improve sustained engagement for greater impact.
• Factors such as insufficient electronic data and perceived lack of benefit may hinder engagement.