Sickle Cell Disease in Latin America and the Caribbean: Where the Care Cascade Breaks Down.

Sickle cell disease causes stroke in childhood and shortens life expectancy. Whether interventions that modify its course reach patients in Latin America and the Caribbean, and where the sequence fails when they do not, remains poorly characterized. This narrative review examines that question for neonatal screening, transcranial Doppler, and hydroxyurea, treating them as a care cascade with steps of detecting the disease, stratifying stroke risk, and reaching disease-modifying therapy. PubMed/MEDLINE, Scopus, Web of Science, and Scientific Electronic Library Online (SciELO) were searched for records published from 1998 to August 2026, and studies were retained when they reported regional data on at least one step of the cascade or on the burden of the disease and access to care in the region. The evidence identified indicates that the sequence breaks at every step, for different reasons at each. Neonatal screening appears widespread as a national program, although the panels do not always include this disease, and detection and linkage to care emerge as separate achievements. For transcranial Doppler, the reviewed evidence shows the widest gap between the strength of the efficacy data and the unevenness of implementation, both between countries and within them. Reported proportions of hydroxyurea use cannot be compared with one another because the denominators behind them differ, and beyond hydroxyurea, the regional evidence for newer therapies is close to absent. Beyond access, the same reports rarely state which ultrasound modality and which genotype-specific reference values were applied, even though both determine the risk category a given velocity falls into. On the evidence identified, closing these gaps appears to depend less on new technology than on population denominators that allow coverage to be expressed against eligible patients, and on an explicit statement of method in the studies the region publishes.