Beyond the Prescription: Hydroxycarbamide Utilization and Adherence Among Persons Living with Sickle Cell Disease in Rural Ghana

Purpose: To assess the utilization and adherence to hydroxycarbamide therapy among sickle cell disease (SCD) patients in a rural Ghanaian setting, and predictors of adherence. Patients and Methods: We conducted a cross-sectional study among 100 SCD patients receiving care at a rural health facility in Ghana. Data were collected using a structured questionnaire administered to adult patients and caregivers of paediatric patients. Descriptive statistics and multivariable logistic regression were used to assess hydroxyurea utilisation, adherence, and associated factors. Results: The study population was predominantly paediatric, with caregivers completing questionnaires for most participants. More than half of the respondents (56%) had use hydroxyurea for over 2 years. While 80% reported always taking the drug, the majority admitted to missing at least one dose in the preceding month. The most reported barriers were forgetfulness (50%) and financial constraints (44.6%). Although gender and educational level were associated with adherence in unadjusted analyses, these factors were not independent predictors in the multivariable logistic regression model. Conclusion: Hydroxyurea utilization in this rural setting is encouraging and reflects the positive impact of national policies such as the "Ahodwo Program". However, adherence challenges persist. This is primarily driven by behavioral and financial barriers than demographic factors. Optimising hydroxyurea use will require targeted interventions, including patient and caregiver education and financial risk protection mechanisms that build on the existing national programs. From a policy perspective, these findings support strengthening caregiver-centred adherence interventions. Future studies should prioritise age-stratified, longitudinal designs to better characterise adherence patterns in adults and children.