title: ENHANCE-(Electronic Hydroxyurea Adherence): A Protocol to Increase Hydroxyurea Adherence in Patients with Sickle Cell Disease.
abstract: BACKGROUND
  Hydroxyurea (HU) is the only disease-modifying medication for patients with sickle cell disease (SCD). HU can reduce SCD-related complications but only 35% to 50% of pediatric patients adhere to HU at the rates achieved in clinical trials and this limits its clinical effectiveness. Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multidimensional, HU adherence intervention that targets many components of the Health Behavior Model.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the impact of Mobile DOT on HU adherence in children with SCD. The objective of our study is to inform the development of future adherence interventions and pediatric SCD protocols.
  
  
  METHODS
  This is a single-arm crossover study of pediatric patients with SCD. Participants self-record videos of their daily HU administrations and receive text message alerts to take HU, feedback on their HU adherence, and incentives when they achieve adherence goals during the 6-month Mobile DOT phase. Participants' HU adherence during the Mobile DOT phase is compared with their baseline HU adherence (6 months prior to study entry) and to their HU adherence 6 months after completing the Mobile DOT phase. The primary outcome of this study is HU adherence measured by medication possession ratio.
  
  
  RESULTS
  The trial is ongoing. Preliminary review of participant satisfaction results suggest that most participants can complete Mobile DOT in less than 5 minutes per day and are satisfied with the intervention.
  
  
  CONCLUSIONS
  If effective, the Mobile DOT strategy will increase HU adherence and this could improve patients' clinical outcomes and reduce costs of care.
authors.affiliation: Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, OH, United States. susan.creary@nationwidechildrens.org.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-4730-8139
authors.initials: S
authors.lastname: Creary
authors.forename: Deena J
authors.identifier: http://orcid.org/0000-0001-5297-9087
authors.initials: DJ
authors.lastname: Chisolm
authors.forename: Sarah H
authors.identifier: http://orcid.org/0000-0001-8855-9746
authors.initials: SH
authors.lastname: O'Brien
keywords: adherence intervention; children; hydroxyurea; sickle cell disease