Test to Treat

The CDC and National Institutes of Health emphasize that rapidly connecting people who test positive for COVID-19 with treatment is effective in decreasing morbidity and mortality from COVID-19. This priority has been emphasized by both President Biden and Governor Newsom. Several treatments are available, effective, and recommended for treatment of non-hospitalized adults and children 12 years of age and older at high risk of progressing to severe COVID-19. To be effective, these treatments must be initiated as soon as possible after diagnosis and within five to seven days of symptom onset.^[1] Pre-exposure prophylaxis is also available for those who qualify under the EUA.^[2] Unfortunately, many vulnerable populations have had lower access to COVID-19 therapeutics, resulting in avoidable hospitalizations and deaths and widening equity gaps^[3].

"Test to treat" pathways streamline the key elements of assessment and treatment (i.e., (1) testing, (2) prescribing, and (3) dispensing medication). With the advent of at-home antigen tests, telehealth, and mail-order medications, expedited test to treat may not necessarily mean patients will have access to all three elements in a single encounter or at a physical site, leading to tremendous opportunity to make each step more accessible and streamlined for patients.

For more information, please refer to the CDPH Therapeutics Playbook that provides information about several different aspects of COVID-19 therapeutics and Test to Treat systems, including clinical guidance and tools, distribution and logistics information, data applications and availability, and best practices for extending a provider network. The California Department of Public Health (CDPH), Physicians for a Healthy California (PHC) and Center for Care Innovation (CCI) has established the COVID-19 Test to Treat Equity grant program to improve access to COVID-19 therapeutics in communities disproportionately affected by COVID-19 and with the greatest barriers to care. 

In addition to the grantee requirements listed above, grantees who receive this additional TA are expected to:

• Identify a project lead that is responsible for day-to-day activities and can coordinate the work of the organization’s project team.** This individual will:
  • Participate in monthly coaching sessions to support their team.
  • Participate in three program Share and Learn sessions where the individual may be asked to present on promising practices or shared challenges for troubleshooting.
• Develop a core project team (~4 people) that will be responsible for developing, implementing and improving the organization’s COVID-19 test-to-treat program. (The project team is invited and encouraged to participate in coaching and Share and Learn sessions, but we realize that not every member will join all sessions.)

*Please refer to the grant guidelines for additional details on eligibility and grant requirements.
**Organizations with multiple clinics should appoint a lead from each clinic to participate in monthly coaching and Share and Learn sessions.

Areas of focus include and are not limited to:

• Development of workflows and processes to ensure patients who are eligible for outpatient COVID-19 therapeutics will receive pre-exposure prophylaxis or treatment in accordance with evidence-based guidelines.^[4] This includes but is not limited to:
  • Expanded ability to dispense medications on site or via outreach teams
  • Expanded telehealth capabilities including advice call line triage
  • Developed surge capacity
  • Support of mobile clinics and home visits, including street medicine providers.Partnerships are encouraged.
  • Developed infusion capabilities 
  • Expanded urgent care and/or same day appointment capacity
  • Coordination of care and services, including ensuring prescription receipt by patient (at preferred pharmacy where medications are available, mail order or courier)
• Enhanced health information technology and data tools in order to better serve and understand the needs of vulnerable populations
• Care coordination, outreach, and member education that facilitates access to pre-exposure prophylaxis medication (Evusheld).
• Providing non-emergency transportation as needed.
• Maintained and tracked utilization data reporting that includes race/ethnicity, zip code, age, primary language, and gender to look for and address disparities in access.
• Review and updating of educational content and materials for providers, patients, and community members, such as clinical advice phone lines, online content, and mailed content and internal policies. This content might encourage testing of those with COVID-19 symptoms, share methods to access COVID testing kits, and outline treatment eligibility with appropriate connection to applicable resources.
• Facilitation of provider education on indications and availability of testing and outpatient pre-exposure prophylaxis and treatment for COVID-19 and how to access it, including information on the NIH COVID Treatment Guidelines^[5]
• Support for the registration of Test to Treat providers and sharing of information about incentives, communications, awareness campaigns, and COVID-19 therapeutics directly from respective local health jurisdictions.