Marginalized populations do not have access to testing sites to treat COVID-19

November 15, 2022

2 minute read


Khazanchi reports receiving a personal honorarium from the New York City Department of Health and Mental Hygiene. Please see the study for relevant financial information from all other authors.

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According to a recent study conducted in JAMA Open Network found.

Rohan KhazanchiMD, MPH, a clinical fellow in the Department of Internal Medicine and Pediatrics at Harvard Medical School, and his colleagues noted that timely access to Paxlovid (nirmatrelvir-ritonavir, Pfizer) and Lagevrio (molnupiravir, Merck) – oral antivirals he have been shown to reduce the risk of hospitalization for patients with mild to moderate COVID-19 is a priority as treatments are “indicated within 5 days of symptom onset”.


Data taken from: Khazanchi R, et al. JAMA Network Open. 2022;doi:10.1001/jamanetworkopen.2022.41144

This urgency heightens the importance of the Test to Treat initiative, a program introduced in March by the Biden administration in which designated locations offer COVID-19 tests, antiviral prescriptions and prescriptions filled at no cost.

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

Using geolocation data from, Khazanchi and his colleagues identified 2,227 unique test-to-treat sites, which were concentrated around major metropolitan areas and thus offered faster travel times for those in the area. suburb. Travel time was calculated from each census tract population site to the nearest 10 test sites to be treated.

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

When disaggregated by race, the researchers found that 30% of American Indians or Alaska Natives lived more than 60 minutes from a test site to treat (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 Indians and Alaska Natives had the highest median driving times among:

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

The researchers noted that the significant driving time for Native American or Alaska Native populations in rural areas suggests “that they are uniquely isolated from accessing antivirals despite carrying a disproportionate burden.” of COVID-19″.

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

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

“This inequity may be associated with low rates of antiviral distribution to the most socially vulnerable areas,” they wrote.

Limitations of the study include driving time that does not account for unequal access to transportation and use of the areas’ population centers, “which assumes that demographic subgroups are not grouped within sectors,” according to the researchers.

Khazanchi and colleagues recommended that equitable distribution schemes ensure that local pharmacies and safety net hospitals are represented in the test-to-treat initiative, that resources are allocated based on equity measures and need. of the community and that outreach “leverages trusted community stakeholders for face-to-face contact”. sensitization.


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