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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

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.35 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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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
1.
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 PubMedGoogle ScholarCrossref
2.
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
3.
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/
4.
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 PubMedGoogle ScholarCrossref
5.
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 PubMedGoogle ScholarCrossref
6.
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.2022.100263PubMedCrossref
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