COVID-19 ‘test to treat’ sites less accessible to many marginalized communities

A new study from investigators at Brigham and Women’s Hospital, a founding member of Mass General Brigham, the University of Virginia School of Medicine, and the University of Pittsburgh, finds that COVID-19 “Test to Treat” sites — clinical centers launched based on a federal initiative to provide free testing, diagnosis, and immediate access to COVID-19 antiviral treatment with Paxlovid — may not be accessible to those who need it most. The study’s findings highlight major disparities in geographical access to these treatment centers, disproportionally affecting rural and American Indian and Alaskan Native communities. Results are published in JAMA Network Open.

“There are clear disparities in spatial access to Test to Treat sites, most notably in several communities which have experienced worse outcomes throughout the pandemic,” said lead author Rohan Khazanchi, MD, MPH, a resident in the Brigham’s Internal Medicine-Pediatrics Residency Program. “These findings challenge us to consider what opportunities exist for strategic placement of Test to Treat sites in closer proximity to the communities that may need this program most.”

This research extends from the Biden administration’s March 2022 announcement of the Test to Treat initiative, a public health program which launched one-stop locations where people can receive a COVID-19 test, speak to a clinician, obtain an antiviral prescription, and fill their prescription for free.

While the Test to Treat initiative aims to increase access to care, this research suggests that geography may play a vital role in achieving equity.

“Paxlovid is an oral antiviral which can reduce the risk of hospitalization or death among people with COVID-19 who have key risk factors like elderly age, being unvaccinated or not being up to date on COVID-19 vaccinations, or having one or more high-risk medical conditions,” said senior author Kathleen McManus, MD, MSc, an assistant professor of medicine in the UVA Health’s Division of Infectious Diseases and International Health. “Notably, these risk factors are disproportionately prevalent among minoritized and rural communities — some of which, as our study found, may have the poorest geographic access to Paxlovid treatment through Test to Treat sites.”

Investigators analyzed published geolocations of 2,227 unique COVID-19 Test to Treat sites from the website, listed as of May 4, 2022. They then calculated the shortest travel time required from the population center of every census tract to reach one of the ten geographically closest sites. Finally, they linked census tract demographic characteristics with calculated driving distances to determine the national proportions of each demographic subgroup residing within a certain driving distance to each site.

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