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Despite limited blood supplies, strategies to reduce their transfusion needs have not been widely evaluated or implemented. We analyzed transfusion utilization in children with SCA before and during hydroxyurea treatment. REACH (Realizing Effectiveness Across Continents with Hydroxyurea, NCT01966731) is a longitudinal Phase I\/II trial of hydroxyurea in children with SCA from Angola, Democratic Republic of Congo, Kenya, and Uganda. After enrollment, children had a two\u2010month pre\u2010treatment screening period followed by 6\u2009months of fixed\u2010dose hydroxyurea (15\u201320\u2009mg\/kg\/day), 18\u2009months of dose escalation, and then stable dosing at maximum tolerated dose (MTD). Characteristics associated with transfusions were analyzed with univariate and multivariable models. Transfusion incidence rate ratios (IRR) across treatment periods were calculated. Among 635 enrolled children with 4124 person\u2010years of observation, 258 participants (40.4%) received 545 transfusions. The transfusion rate per 100 person\u2010years was 43.2 before hydroxyurea, 21.7 on fixed\u2010dose, 14.5 during dose escalation, and 10.8 on MTD. During MTD, transfusion incidence was reduced by 75% compared to pre\u2010treatment (IRR 0.25, 95% confidence interval [CI] 0.18\u20130.35, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001), and by 50% compared to fixed dose (IRR 0.50, 95% CI 0.39\u20130.63, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Hydroxyurea at MTD decreases transfusion utilization in African children with SCA. If widely implemented, universal testing and hydroxyurea treatment at MTD could potentially prevent 21% of all pediatric transfusions administered in sub\u2010Saharan Africa. Increasing hydroxyurea access for SCA should decrease the transfusion burden and increase the overall blood supply.<\/jats:p>","DOI":"10.1002\/ajh.27244","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T06:48:40Z","timestamp":1707461320000},"page":"625-632","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Reducing transfusion utilization for children with sickle cell anemia in sub\u2010Saharan Africa with hydroxyurea: Analysis from the phase <scp>I<\/scp>\/<scp>II REACH<\/scp> trial"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5823-0218","authenticated-orcid":false,"given":"Alexandra","family":"Power\u2010Hays","sequence":"first","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Department of Medicine University Health Network, Toronto General Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6318-0227","authenticated-orcid":false,"given":"Leon","family":"Tshilolo","sequence":"additional","affiliation":[{"name":"Department of Medicine Centre Hospitalier Monkole  Kinshasa Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Br\u00edgida","family":"Santos","sequence":"additional","affiliation":[{"name":"Instituto Hematol\u00f3gico Pedi\u00e1trico Hospital Pedi\u00e1trico David Bernardino  Luanda Angola"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-2382","authenticated-orcid":false,"given":"Thomas N.","family":"Williams","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Programme  Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Olupot\u2010Olupot","sequence":"additional","affiliation":[{"name":"Mbale Clinical Research Institute Mbale Regional Referral and Teaching Hospital\u2010Busitema University  Mbale Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4083-0060","authenticated-orcid":false,"given":"Luke R.","family":"Smart","sequence":"additional","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9934-5161","authenticated-orcid":false,"given":"Banu","family":"Aygun","sequence":"additional","affiliation":[{"name":"Division of Hematology Cohen Children's Medical Center of New York  New Hyde Park New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Lane","sequence":"additional","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Stuber","sequence":"additional","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Latham","sequence":"additional","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell E.","family":"Ware","sequence":"additional","affiliation":[{"name":"Division of Hematology and Global Health Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(23)00118\u20107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)30193\u20109"},{"key":"e_1_2_10_4_1","first-page":"93","volume-title":"Transfusion Support for Patients with Sickle Cell Disease","author":"Power\u2010Hays A","year":"2022"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(19)30200\u20105"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/voxs.12468"},{"key":"e_1_2_10_7_1","unstructured":"World Health Organization.Global status report on blood safety and availability. 2017. 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