Published in PLOS One on 2026-05-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Josephine Mensah, Afia Frimpomaa Asare Marfo, Mercy Naa Aduele Opare-Addo, Paul Obeng, Amos Amoako-Adusei, Karl Osei Afoduo, Bright Ansah Adjei, Pauline Boachie Ansah, Kwame Ohene Buabeng
Source: PLOS One • DOI 10.1371/journal.pone.0347848
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Hydroxyurea is a vital medication for managing Sickle cell disease, yet access and adherence remain significant challenges in low-resource settings. This qualitative study explored challenges and opportunities in hydroxyurea access and adherence among Sickle cell disease patients at the Komfo Anokye Teaching Hospital in Ghana. Alongside, the utility of the Ahodwo CommCare mobile App in enhancing Sickle cell disease management was explored. Semi-structured interviews were conducted with six healthcare providers, including doctors, nurses, and pharmacists from May 12 to August 15, 2022. This study found that the key barriers to hydroxyurea access and adherence include financial constraints, medication stock-outs, administrative inefficiencies, bureaucratic delays, patient-related factors such as forgetfulness and concerns about side effects, and practical challenges in administering the medication especially to children. The healthcare workers indicated that reconstituting the medication into suspension added both cost and time constraints to children who cannot take capsules hence affecting access to hydroxyurea. Facilitators to access and adherence identified included patient education, streamlined procurement processes, and government support for medication subsidies. This study found that patient education sessions should emphasize the benefits of hydroxyurea treatment and the importance of adherence to prescribed regimens. The study also revealed limited awareness and utilization of the Ahodwo CommCare app among healthcare personnel, highlighting the need for targeted training and integration into clinical workflows. These findings underscore the importance of multifaceted interventions involving healthcare workers, hospital management, and government stakeholders to improve hydroxyurea access and adherence, ultimately enhancing Sickle cell disease patient outcomes.
Introduction
Sickle cell disease (SCD) is a significant public health challenge in sub-Saharan Africa, with Ghana bearing a high burden of the disease [1–4]. Hydroxyurea (HU) has proven to be an effective therapy for reducing complications and improving the quality of life for SCD patients [5–10]. HU is a myelosuppressive agent which provides therapeutic benefits in the management of SCD across all ages and is readily absorbed upon oral administration [11]. During the first four to six weeks of administering HU, the mean cell volume (MCV) increases, before the cells bearing Fetal Hemoglobin (HbF) expand, a situation that is associated with decreases in vaso-occlusive crisis (VOC) events [12]. However, access and adherence to HU remain suboptimal due to systemic, facility-related, and patient-level barriers [8,13–17]. Several factors have been identified as the cause of high SCD related deaths and reduced quality of life in these settings. Some of the factors include unavailability of established programs for neonatal SCD screening, poorly managed neonatal screening programs for SCD, inadequate information sharing and education of stakeholders about successful evidence-based treatment options, poor access to required medications and essential clinical support services, and limited healthcare facilities [1].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Josephine Mensah, Afia Frimpomaa Asare Marfo, Mercy Naa Aduele Opare-Addo, Paul Obeng, Amos Amoako-Adusei, Karl Osei Afoduo, Bright Ansah Adjei, Pauline Boachie Ansah, Kwame Ohene Buabeng. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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