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Health Policy

Geographic Accessibility of COVID-19 Test to Treat Sites by Race, Ethnicity, Age, and Rurality

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: November 9, 2022

Research Letter

Article Information and Disclosures

Rohan Khazanchi, MD, MPH^1,2,3;

Andrew Strumpf, MPH⁴;

Utibe R. Essien, MD, MPH^5,6;

Samuel D. Powers, MA⁴;

Kathleen A. McManus, MD, MSCR^4,7

Author Affiliations

¹Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts
²Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
³Internal Medicine-Pediatrics Residency Program, Brigham and Women’s Hospital, Boston Children’s Hospital, Boston Medical Center, Boston, Massachusetts
⁴Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville
⁵Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
⁶Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
⁷Global Infectious Diseases Institute, University of Virginia, Charlottesville

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Nirmatrelvir-ritonavir and molnupiravir are oral antivirals that reduce risk of hospitalization for people with mild to moderate COVID-19.¹ Timely access to treatment is a priority because these medications are indicated within 5 days of symptom onset. In March 2022, the Biden Administration announced the Test to Treat initiative to designate one-stop locations where people can receive a COVID-19 test, speak with a clinician, obtain an antiviral prescription, and fill the prescription for free.² However, concerns remain that the Test to Treat program may not be accessible for minoritized and high-risk populations.³^- 5 To explore geographic disparities in antiviral access, we quantified the accessibility of Test to Treat sites for subpopulations by race, ethnicity, age, and rurality.

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Article Information

Accepted for Publication: September 13, 2022.

Published: November 9, 2022. doi:10.1001/jamanetworkopen.2022.41144

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Khazanchi R et al. JAMA Network Open.

Corresponding Author: Rohan Khazanchi, MD, MPH, Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115 (rkhazanchi@bwh.harvard.edu).

Author Contributions: Dr Khazanchi and Mr Strumpf had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Khazanchi, Strumpf, Powers, McManus.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Khazanchi, Essien.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Khazanchi, Strumpf, Powers.

Obtained funding: McManus.

Administrative, technical, or material support: Strumpf, Powers, McManus.

Supervision: McManus.

Conflict of Interest Disclosures: Dr Khazanchi reported receiving personal fees from the New York City Department of Health and Mental Hygiene and grants from the Infectious Diseases Society of America Foundation outside the submitted work. Dr Essien reported receiving grants from the Department of Veterans Affairs outside the submitted work. Mr Powers reported receiving grants from the University of Virginia Global Infectious Diseases Institute during the conduct of the study. Dr McManus reported receiving grants from and owning stock in Gilead Sciences Inc outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the University of Virginia Global Infectious Diseases Institute.

Role of the Funder/Sponsor: The University of Virginia Global Infectious Diseases Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: The statistical code is available on request from Mr Strumpf (as9qn@virginia.edu). Data sets are publicly available from sources noted in Methods.

References

Gandhi RT , Malani PN , Del Rio C . COVID-19 therapeutics for nonhospitalized patients. JAMA. 2022;327(7):617-618. doi:10.1001/jama.2022.0335 PubMed Google Scholar Crossref

US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR). Test to Treat. Accessed May 16, 2022. https://aspr.hhs.gov:443/TestToTreat/Pages/default.aspx

Khazanchi R , Marcelin J , Abdul-Mutakabbir J , Essien U . Race, racism, civil rights law, and the equitable allocation of scarce COVID-19 treatments. Health Affairs Forefront. Published February 10, 2022. Accessed September 9, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20220208.453850/full/

Gold JAW , Kelleher J , Magid J , et al. Dispensing of oral antiviral drugs for treatment of COVID-19 by zip code–level social vulnerability—United States, December 23, 2021-May 21, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(25):825-829. doi:10.15585/mmwr.mm7125e1 PubMed Google Scholar Crossref

Wiltz JL , Feehan AK , Molinari NM , et al. Racial and ethnic disparities in receipt of medications for treatment of COVID-19—United States, March 2020-August 2021. MMWR Morb Mortal Wkly Rep. 2022;71(3):96-102. doi:10.15585/mmwr.mm7103e1 PubMed Google Scholar Crossref

Abdul-Mutakabbir JC , Hirsch EB , Ko C , et al. A call to action: a need for initiatives that increase equitable access to COVID-19 therapeutics. Lancet Reg Health Am. 2022;11:100263. doi:10.1016/j.lana.2022.100263 PubMed Crossref

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.