Many youth with chronic disease have difficulty taking medication every day and therefore do not receive full benefit from treatment. Sickle Cell Disease (SCD) is an inherited blood disease that affects African Americans and other underserved communities. Hydroxyurea (HU) is the sole FDA-approved drug therapy for SCD and is highly effective and improves quality of life. The proposed study, a 5-site four-year randomized control trial (RCT), builds upon the investigators' recent feasibility study of the same title. Overall goals are reducing barriers to HU use and improving adherence for youth 10-18 years through creation of a daily medication habit. The goal of the proposed multi-site study is to test the efficacy of the HABIT intervention at 6 months and sustainability of the effect at 12 months.
Barriers to medication adherence are common in youth with chronic illness and are a source of racial/ethnic disparities in underserved communities. An inherited blood disease, Sickle Cell Disease (SCD) is characterized by chronic and acute illness and reduced quality of life (QOL). It affects African Americans and other underserved communities. Hydroxyurea (HU) is the sole FDA-approved drug therapy for SCD and is highly effective and improves QOL. Poor adherence is common among youth and young adults with SCD. The importance of poor medication adherence, use of community-based health workers (CHWs) to bridge the gap between health services and underserved parent-youth dyads affected by SCD, the strength of the science, the success of the investigators' multi-ethnic feasibility study, and the potential application of study findings to youth with other serious chronic illnesses speak to the importance of this trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
50
Dyads randomized to the intervention group will receive the HABIT intervention, which includes CHW support and tailored text messages.
Standard of care used to treat patients with SCD
Education materials provided to all patients enrolled in the trial
Feinstein Institute for Medical Research
Manhasset, New York, United States
Columbia University Irving Medical Center
New York, New York, United States
Albert Einstein College of Medicine
The Bronx, New York, United States
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Mean Change in Biomarker Fetal Hemoglobin (HbF)
A serum biomarker obtained from youth used to measure adherence to hydroxyurea
Time frame: Baseline, 6 months, 12 months
Mean Change in Proportion of Days Covered (PDC) by Hydroxyurea
The days covered by hydroxyurea was assessed using youth prescription refill data and was used to measure hydroxyurea adherence. The baseline measure is the proportion of days covered by hydroxyurea in the year prior to study enrollment, using prescription refill data.
Time frame: Baseline, 6 months, 12 months
Mean Change in Youth Score on Peds Quality of Life (Generic Quality of Life)
Used to measure health-related quality of life. Scores range from 0-100 with a higher score indicating a better quality of life.
Time frame: Baseline, 4 months, 9 months and 12 months
Mean Change in Youth Score on PedsQL Sickle Cell Disease Module (Disease Specific Quality of Life)
Used to measure sickle cell disease specific health-related quality of life. Scores range from 0-100 with a higher score indicating a better quality of life.
Time frame: Baseline, 9 months and 12 months
Mean Change in Parent Youth Concordance Regarding Self-management Responsibility
Concordance between parent and youth scores Sickle Cell Family Responsibility scores for 11 items measuring self-management tasks. Scores range from 0-11 with a higher score indicating better concordance.
Time frame: Baseline, 6 months and 12 months
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