Problems In Accessibility May Reduce Effectiveness of The Test to Treat Program - medtigo



Problems In Accessibility May Reduce Effectiveness of The Test to Treat Program

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According to a new study published in JAMA Network Open, 15% of Americans lack access to life-limiting oral antivirals because they live more than an hour away from the nearest COVID-19 Test to Treat facility. 

Researchers from Brigham and Women’s Hospital and the University of Virginia used HealthData.gov data to identify 2,227 Test to Treat sites across the United States as of May 4, 2022. They also assessed how long it would take to get to the test sites from the major cities in each of the United States ten Census regions.  

As previously reported by medtigo, the Biden administration unveiled the Test to Treat initiative. The project provided a single place where persons suffering from mild to severe diseases could be tested for COVID-19, seen by a doctor, given a prescription for the antiviral medications Paxlovid or Lagevrio, and then have their medication filled.  

To lessen the likelihood of hospitalization, the medications must be begun within five days of the commencement of symptoms. Everyone has the right to know if they are infected with COVID-19 to protect themselves, their loved ones, and their communities. A rapid antigen test can detect COVID-19 cases in the home or other non-clinical settings, providing valuable information for deciding on interventions such as isolation, contact tracing, and antiviral treatment. But the real problem with the effectiveness of the Test to Treat program lies.

Most Test to Treat clinics were located in or near extensive urban areas, making them more accessible to citizens. The average driving time to the nearest destination is more than an hour for 59% of Americans who reside in rural areas.  

While PCR testing is the gold standard for detecting COVID-19, rapid testing can aid in identifying cases with mild symptoms, allowing them to be isolated and prevented from spreading. Rapid testing is required to access nirmatrelvir/ritonavir and other COVID-19 antiviral treatments as they become more widely available.  

IMPAACT4C19 and The Treatment Action Group created this factsheet to help you learn more about rapid antigen tests, how to use them, and how to advocate for greater access to these critical risk-reduction tools during the ongoing coronavirus pandemic.  

According to senior author Kathleen McManus, MD, of the University of Virginia, in a press release distributed by Brigham, this is especially important for patients “who have major risk factors such as old age, being unvaccinated or not up to date on COVID-19 immunizations, or having one or more high-risk medical conditions.” These risk factors are prevalent in minority and rural communities.  

One in every seven persons over the age of 60, 30% of those of American Indian/Alaska Native (AIAN) descent, 17% of whites, 8% of Hispanics, and 8% of blacks had to drive more than sixty minutes to reach a medical institution for care. On average, Asians and Pacific Islanders spent 28.5 minutes longer than Whites to leave their homes and get to a testing venue. The average duration for Asian Americans was 8 minutes, 9.2 minutes for Hispanics, and roughly 10 minutes for Blacks.  

Travel time averaged 69.2 minutes for those living in the countryside and 11.0 minutes for those living in the city. The results were consistent across all demographics. The AIAN population stands out as having the most extended median commute times of any group, urban or rural (13.8 vs. 74.9 minutes, respectively). Researchers observed that the typical rural individual spent 58 minutes more than their urban counterparts going to the nearest Test to Treat clinic.  


Even after correcting for rurality, American Indian or Alaska Native people had longer travel times, indicating that they are significantly distanced from antiviral availability, although incurring a more considerable COVID-19 burden.

This shows that extending Test to Treat to include more rural and tribal clinics may improve access to marginalized groups. However, researchers discovered that proximity alone was insufficient to ensure equitable access to opioids, even though people of Asian, Black, and Hispanic origins lived closer to sites than people of AIAN origins.  

Poor antiviral dispensing rates may be linked to this injustice. They discovered that “despite a higher risk of infection and severe illness, these populations have been less likely to obtain outpatient COVID-19 therapy than White individuals.”The authors claimed that it would be more beneficial if more FQHCs, safety-net hospitals, and community pharmacists participated in the Test to Treat initiative.

They also advocated for a low-tech, high-touch approach in which trusted community members make in-person contact and resources are dispersed based on equality criteria and community needs.  

According to coauthor Utibe Essien, MD, MPH, of the University of Pittsburgh, new data from the Centers for Disease Control and Prevention show that racial disparities in COVID-19 antiviral treatment persist. He claims that the lack of Internet access for telemedicine services, limited transportation options, and language barriers are all examples of long-standing structural constraints that must be overcome if pharma co-equity is to be realized. 



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