"My mum cannot buy for me and leave my sibling out": experiences of hydroxyurea use among people living with sickle cell disease in Ghana

Pain management remains a crucial aspect of tackling the burden of sickle cell disease (SCD) in low and middle-income countries (LMICs), including Ghana. Research shows that hydroxyurea (HU) has become a common medication for managing pain in SCD patients in LMICs. However, there are limited studies on the experiences of HU use among people with SCD in LMICs. Addressing a critical research gap, this study explores the enablers and barriers to HU use among people with SCD in Ghana. This study is crucial for delivering health interventions to enhance health-related quality of life among people with SCD in Ghana. Using a phenomenological approach, this study was conducted in the Ashanti Region of Ghana. A total of 27 people with SCD were recruited between October 2022 and November 2022 using convenience sampling. Interview guides were used to collect data on sociodemographic factors, enablers of HU, and barriers to HU use among individuals with SCD. Data were analysed using thematic analytical frameworks. This study demonstrated that the inclusion of HU in the national health insurance scheme (NHIS), along with HU’s effectiveness, facilitated the use of HU among the participants. This study further revealed that knowledge deficit, availability of alternative medications, high cost and administrative burden were identified as barriers to HU use among the participants. This study has identified several factors that promote and/or hinder the use of HU among people with SCD in Ghana. The findings highlight the importance of implementing health interventions, such as regular health education programs at health facilities across Ghana, to educate people about HU, thereby increasing awareness and encouraging HU uptake. It also recommends that, since HU is covered under the NHIS, people with SCD who do not have NHIS coverage should be encouraged and financially supported by their families to enrol in the NHIS to reduce the costs associated with using HU.