Test to Treat: geographic disparities in COVID-19 antiviral access

By Tarun Sai LomteNov 14 2022Reviewed by Danielle Ellis, B.Sc.

A recent study published in the Journal of American Medical Association (JAMA) Network Open evaluated the accessibility of coronavirus disease 2019 (COVID-19) ‘Test to Treat’ sites by age, rurality, race, and ethnicity.

Background

The ‘Test to Treat’ initiative was announced in March 2022 in the United States (US) to help people access treatments for COVID-19. Individuals can take COVID-19 tests, speak with a healthcare provider, receive prescriptions for oral antiviral therapy, and have the prescription filled at one location. However, there are concerns that high-risk and minority populations may be unable to access this program.

The study and findings

In the current study, researchers assessed geographic disparities in access to COVID-19 Test to Treat sites for population subsets by age, rurality, ethnicity, and race. The researchers analyzed the geographic locations of all Test to Treat sites and estimated drive times from the population center to the ten closest sites to determine the shortest time.

Next, they computed the national proportion of demographic sub-groups within X min of the closest location by weighting all census tracts by population size, stratified by population demographics at the census tract level, and aggregating drive times by demographic sub-group. The median drive times per sub-group were calculated with 95% confidence intervals (CIs).

The researchers identified more than 2220 unique COVID-19 Test to Treat sites distributed near metropolitan centers. Shorter drive times were prominent in urban regions. 15% of the overall US population lived more than 60 min from the nearest Test to Treat site, whereas 59% of the rural US population lived more than an hour from the closest location.

Overall, 17% of older adults, 30% of Alaskan Native or American Indian individuals, 8% of Hispanics, 8% of Black individuals, and 17% of White individuals were more than one hour away from the closest site. Alaskan Native or American Indian individuals (28.5 min) lived farther from the Test to Treat sites than White individuals (13.9 min).

In contrast, Hispanics (9.2 min), Black individuals (10 min), and Asians (8 min) lived closer to the Test to Treat sites than White individuals. Rural dwellers (69.2 min) had longer drive times to the Test to Treat centers than urban dwellers (11 min), which remained concordant across demographic sub-groups. Notably, Alaskan Natives or American Indians had the longest drive times across rural (74.9 min) and urban (13.8 min) sub-populations.

Conclusions

In summary, the study observed that 15% of the US population, 59% of the rural people, and 30% of Alaskan Native or American Indian individuals lived more than 60 min away from the nearest COVID-19 Test to Treat site. Rural residents had a 58-min longer drive to the nearest location than urban residents.

Though Asian, Hispanic, and Black individuals lived nearby the Test to Treat sites, geographic accessibility solely may not reflect pharmacoequity. Therefore, equitable distribution schemes must ensure the representation of safety-net hospitals, local pharmacies, and health centers in the Test to Treat program.