Marginalized populations lack access to COVID-19 test-to-treat sites

Rural and American Indian and Alaska Native populations face significant distance barriers to COVID-19 test-to-treat sites, a recent study in JAMA Open Network found.

Rohan Khazanchi, MD, MPH, a clinical fellow in the department of internal medicine and pediatrics at Harvard Medical School, and colleagues noted that timely access to Paxlovid (nirmatrelvir-ritonavir, Pfizer) and Lagevrio (molnupiravir, Merck) — oral antivirals that have been shown to reduce the risk for hospitalization in patients with mild- to moderate-COVID-19 — is a priority due to the treatments being “indicated within 5 days of symptom onset.”

That urgency increases the importance of the test-to-treat initiative, a program introduced in March by the Biden administration in which designated locations offer COVID-19 testing, antiviral prescriptions and prescription fills at no cost.

“However, concerns remain that the Test to Treat program may not be accessible for minoritized and high-risk populations,” Khazanchi and colleagues wrote.

Utilizing geolocation data from HealthData.gov, Khazanchi and colleagues identified 2,227 unique test-to-treat sites, which were concentrated around major metropolitan areas and thus offered shorter drive times for those in suburban settings. Drive time was calculated from the population site of every census tract to the 10 closest test-to-treat sites.

The researchers noted that 15% of the total U.S. population lived 60 minutes away from a test-to-treat site, while that proportion increased to 59% for rural residents, who drove a median of 69.2 minutes (95% CI, 68.5-70.7) vs. a median of 11 minutes (95% CI, 10.9-11.1) among urban residents.

When broken down by race, the researchers found that 30% of American Indian or Alaska Native individuals lived more than 60 minutes away from a test-to-treat site (28.5 minutes; 95% CI, 25.9-31.1). Meanwhile, 17% of white individuals (median, 13.9 minutes; 95% CI, 13.8-14.1), 8% of Black individuals (median, 10 minutes; 95% CI, 9.9-10.1) and 8% of Hispanic individuals (median, 9.2 minutes; 95% CI, 9.1-9.4) lived more than 60 minutes from the nearest site.

American Indian and Alaska Native individuals had the highest median drive times among both the:

• urban subpopulation (13.8 minutes; 95% CI, 13.0-14.7); and
• rural subpopulation (74.9 minutes; 95% CI, 68.2-81.2).

The researchers noted the significant drive time for American Indian or Alaska Native populations in rural areas suggests “that they are uniquely isolated from antiviral access despite bearing a disproportionate COVID-19 burden.”

“Expanding inclusion of rural and tribal facilities in the Test to Treat initiative may improve access for these populations,” they wrote.

Additionally, while Black, Asian and Hispanic populations had shorter distances to test-to-treat sites, Khazanchi and colleagues pointed out that geographic accessibility alone “is insufficient for pharmacoequity,” as those groups are less likely to receive outpatient COVID-19 therapeutics than white individuals despite higher risks for infection.

“This inequity may be associated with low antiviral dispensing rates in areas with highest social vulnerability,” they wrote.

Limitations of the study include drive time not accounting for unequal transportation access and the use of tract population centers, “which assumes that demographic subgroups are not clustered within tracts,” according to the researchers.

Khazanchi and colleagues recommended that equitable distribution schemes should ensure local pharmacies and safety-net hospitals are represented in the test-to-treat initiative, resources are allocated based on equity metrics and community needs and that outreach “leverages trusted community stakeholders for in-person outreach.”

References:

• COVID-19 ‘test to treat’ sites less accessible to many marginalized communities. https://www.eurekalert.org/news-releases/970691. Published Nov. 9, 2022. Accessed Nov. 11, 2022.
• Khazanchi R, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.41144.