(115) Impact of telehealth on hydroxyurea adherence and clinical outcomes in sickle cell disease management: A systematic review and meta-analysis

Background: : Hydroxyurea (HU) remains the cornerstone of pharmacologic management for sickle cell disease (SCD), yet adherence rates remain suboptimal due to barriers such as side effect concerns, limited disease understanding, forgetfulness, lack of regular follow ups and systemic healthcare barriers. Telehealth interventions have emerged as promising tools to improve medication adherence and clinical outcomes in chronic diseases, including SCD.

Objective: : To synthesize new evidence on the impact of telehealth interventions on hydroxyurea adherence and associated clinical outcomes in individuals with sickle cell disease (SCD).

Methods: : A systematic search of PubMed, Embase, Web of Science, and PsychInfo was conducted to identify studies published through April 2025 that evaluated telehealth interventions, such as mobile applications, SMS reminders, video-based therapy, and phone counseling, targeting HU adherence in SCD. Random-effects meta-analyses were performed using standardized mean differences (SMD) to estimate pooled effects. Subgroup and sensitivity analyses were conducted based on adherence measures and study design. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools.

Results: : Five(5) studies involving 362 participants met the inclusion criteria, comprising one randomized controlled trial and four quasi-experimental studies. Telehealth interventions were associated with a significant improvement in HU adherence (pooled SMD = 0.91; 95% CI: 0.62 to 1.20; I² = 17.8%). The 95% predictive interval ranged from 0.52 to 1.90, indicating the likely effect size in future settings. Subgroup analyses revealed consistent effects across different adherence measures (MPR, PDC) and study designs. Secondary outcomes, including increases in mean corpuscular volume (MCV) and fetal hemoglobin (HbF), showed favorable trends but were not uniformly reported. Sensitivity analyses confirmed the robustness of findings, and Egger’s test suggested the low risk of publication bias

Conclusions: : Telehealth interventions significantly improve hydroxyurea adherence among patients with sickle cell disease and show promise in enhancing key clinical outcomes. Broader implementation and evaluation of scalable, culturally tailored digital tools are warranted, particularly in underserved populations.

Sponsorship:: None