RESUMEN
Background: COVID-19 vaccine booster uptake remains low and preventable COVID-19 deaths continue to occur, making access to oral antivirals for those most at risk of severe COVID-19 outcomes essential. Method(s): We estimated age and gender adjusted prevalence ratios of oral nirmatrelvir-ritonavir (NMV/r) uptake by sociodemographics, clinical characteristics, and prescription eligibility (based on age, underlying medical conditions, body mass index, physical inactivity, pregnancy, or smokers), among participants in a large U.S. national prospective cohort who were infected with SARS-CoV-2 between December 2021 and October 2022. Among participants who reported NMV/r uptake, we also described the proportion who reported (1) taking NMV/r as directed and (2) NMV/r was helpful for reducing COVID-19 symptoms. Result(s): Among 1,594 participants with a SARS-CoV-2 infection as of October 2022, 1,356 were eligible for NMV/r prescription;of whom 209 (15.4% [95%CI:13.5-17.3]) reported receiving NMV/r. NMV/r uptake increased from 2.2% (95%CI:1.0-3.4) between December 2021 and March 2022 to 16.5% (95% CI:13.0-20.0) between April and July 2022 and 28.6% (95%CI:24.4-32.8) between August and October 2022, respectively. Participants >=65 years of age reported the highest uptake of NMV/r (30.2% [95%CI:22.2-38.2]). Black non-Hispanic participants (7.2% [95%CI:2.4-12.0]) and those in the lowest income group (10.6% [95%CI:7.3-13.8]) had lower uptake than white non-Hispanic (15.8% [95%CI:13.6-18.0]) and high-income individuals (18.4% [95%CI:15.2-21.7]), respectively. Participants with type 2 diabetes had greater uptake (28.8% [95%CI:20.4-37.3]), compared to those without it (12.4% [95%CI:4.8-20.0]). Among a subset of 278 participants who had a prior SARSCoV-2 infection, those who had a history of long COVID reported greater uptake (22.0% [95%CI:13.9-30.1]) for a subsequent SARS-CoV-2 infection than those without a history of long COVID (7.9% [95%CI:3.9-11.8]). Among all participants who were prescribed NMV/r (N=216), 89% (95%CI:85-93) reported that they took NMV/r as directed and 63% (95%CI:57-70) stated NMV/r was helpful for reducing COVID-19 symptoms. Conclusion(s): Uptake of NMV/r increased over time coinciding with national efforts to increase awareness and access. However, most individuals who were eligible for NMV/r did not receive it. Lower NMV/r uptake among racial/ethnic minorities and individuals with lower household income suggests a need to improve awareness and address barriers to uptake in these populations.
RESUMEN
Background: Epidemiologic risk factors for SARS-CoV-2 infection are best characterized via prospective cohort studies, complementing case-based surveillance and cross-sectional seroprevalence studies. Methods: We estimated the cumulative incidence of SARS-CoV-2 infection and incidence rates of seroconversion in a national prospective online cohort of 6745 US adults, enrolled during March-July 2020. A subset (n=4459) underwent serologic testing (Bio-Rad Platelia Total Ab, IgA/IgM/IgG), offered initially during May-Sept. 2020 and again in Nov. 2020-Jan. 2021. Results: A total of 303 of 4459 individuals showed serologic evidence of past SARS-CoV-2 infection (6.8%, 95%CI 6.1-7.6%). Among 3280 initially seronegative participants who had a subsequent serologic test, there were 145 seroconversions over 1562 person years of follow-up (incidence rate=9.3 per 100 person-years [95%CI 7.9-11.0]). Racial/ethnic disparities in crude incidence rates were apparent through Jan. 2021 (rate ratio [RRHispanic v White]=2.1, 95%CI 1.4-3.1;RRnon-Hispanic Black v White=1.8, 95%CI 0.96- 3.1). Incidence was higher in the southern (RRSouth v Northeast=1.7, 95%CI 1.1-2.8) and midwest (RRmidwest v Northeast=1.6, 95%CI 0.98-2.7) regions, in rural v urban areas (RR=1.5, 95%CI 1.0-2.2), and among essential workers (RR=1.7, 95%CI 1.1-2.5). Household crowding (RR=1.6, 95%CI 1.1-2.3), indoor restaurant dining (RR=2.0, 95%CI 1.4-2.8), visiting places of worship (RR=2.0, 95%CI 1.3-2.9), wearing masks sometimes (v always) while grocery shopping (RR=2.5, 95%CI 1.3-4.4), not wearing masks when visiting people outside the household (RRsometimes v always=1.3, 95%CI 0.88-2.1;RRnever v always=2.0, 95%CI 1.2-3.2), gathering in groups of >10 (RRindoors v never=1.74, 95%CI 1.2-2.5;RRoutdoors v never=1.8, 95%CI 1.3-4.3), and recent air travel (RR=1.7, 95%CI 1.1-2.6) were associated with higher incidence. Among 303 seropositive persons, 27.4% had asymptomatic infections and 32% reported a positive SARSCoV- 2 PCR test or provider diagnosis. There were major gaps in the uptake of public health interventions aimed at isolation (31%) and contact tracing (asked about contacts [18%];told about exposure to a case [7.6%]). Conclusion: Modifiable risk factors and low uptake of public health strategies drive SARS-CoV-2 transmission across the US. It is critical to address inequities in incidence, reduce risk factors, and improve the reach of public health strategies.