Streamlining Test-to-Treat: A Novel Care Delivery Model for Covid-19 Oral Antiviral Access to Close the Equity Divide in Los Angeles County

ABSTRACT

The Los Angeles County Department of Public Health, in collaboration with Healthvana, a well-established private-sector partner, was able to quickly stand up a program to target patients in socially and economically disadvantaged communities for access to time-sensitive oral antiviral remedies. The Covid-19 pandemic has revealed the urgent need for a new care model that serves socially and economically disadvantaged communities by providing timely and widespread access to therapeutics that is free of cost to the patient and agnostic to insurance status, provider, and physical location of Covid-19-positive individuals. The Los Angeles County Department of Public Health (LAC DPH) - in partnership with Healthvana, a Health Insurance Portability and Accountability Act of 1996-compliant patient engagement platform that digitally delivers test results directly to patients and providers - piloted an innovative treatment-dispensing model cost-free to the patient to address both inequitable access and the time-sensitive nature of Covid-19 medication prescriptions - in particular, oral antivirals such as Pfizer's Paxlovid. The intervention combined confidential digital delivery of Covid-19 test results, antiviral education, and direct access to therapeutics within hours of a positive polymerase chain reaction (PCR) result for severe acute respiratory syndrome coronavirus 2 infection. Between April 5 and July 5, 2022, this care model delivered 25,237 PCR-positive test results from 77 LAC DPH Covid-19 test sites and enabled patients to connect with a clinician within hours of receiving a positive test result to receive a free Covid-19 screening and prescription for Covid-19 antiviral treatment. During that 3-month period, 1,471 prescriptions for oral antivirals were prescribed through the LAC DPH telehealth line, and 1,177 of those patients who were contacted via a follow-up survey had filled their prescriptions. Success was attributable to rapid rollout, leveraging Healthvana's existing infrastructure and brand recognition built over the preceding 2 years of the pandemic, and provision of an instant-access medical consult and prescription cost-free to patients. This intervention demonstrates the potential for digital health technologies to facilitate more equitable interventions at the intersection of public health and clinical practice.