Standing Up a Test to Treat Model During a Surge of COVID-19 Cases

Posted In: People born outside of the US, People from racial and ethnic minority groups

COVID-19 testing event in Puerto Rico in a parking lot with tents and trees

Purpose

Provide quick one-stop access to COVID-19 testing, medical evaluation, and treatments. Link COVID-19 positive patients to time-sensitive treatments during the Omicron surge in Puerto Rico. Eliminate barriers that prevent patients from quickly receiving COVID-19 monoclonal or antiviral treatments to help decrease their risk of hospitalization.

Populations of focus

People from racial and ethnic minority groups and people born outside of the U.S.

Description

The highly transmissible Omicron variant was responsible for the biggest surge in COVID-19 cases in Puerto Rico (PR). By December 18, 2021, Omicron was the dominant variant on the island, contributing to high community transmission and a record high test positivity rate of 39% on January 6, 2022.

To respond, the Puerto Rico Department of Health (PRDOH) scaled up COVID-19 testing and ran more than 80 testing events in one week. However, there was still a need to develop a system to rapidly link COVID-19 positive patients to lifesaving treatments that help improve health outcomes.

Two new oral treatments, Molnupiravir and Paxlovid, received Emergency Use Authorization (EUA) from the U.S. Federal Drug Administration (FDA) at the end of December 2021. The week of December 27th, Puerto Rico received both antivirals under the EUA and rapidly distributed them to over 50 pharmacies around the island.

Early Impact

On January 24, 2022, antivirals were integrated into a testing and treatment site located in the northern region of the island at the Government Hospital located in the municipality of Bayamón. This became the first site in PR with the capacity to provide quick one-stop access to testing, medical evaluation, and COVID-19 monoclonal or antiviral treatment. PRDOH and clinical staff from the Puerto Rico National Guard provided services seven-days-a-week at the hospital from 8:00 AM to 4:00 PM and implemented a drive-through strategy to facilitate testing and treatment delivery.

Individuals with positive COVID-19 results were immediately evaluated on-site to determine if they were eligible for either monoclonal or antiviral therapy. Through this model, patients were tested, evaluated for most appropriate treatment, received a prescription from a licensed healthcare provider, and immediately received the pills or monoclonal infusion – all at one location. Education on COVID-19 infection prevention and treatment options was also offered on-site.

Lessons Learned

From January 24 to September 30, 2022, 17,395 people were tested at the Bayamón site in Puerto, and 6,844 were eligible and received COVID-19 treatment. This Test to Treat site continues to operate, allowing quick access to COVID-19 treatments to reduce disease severity in individuals who are at high risk of developing a severe illness from COVID-19.

Early in March, the Office of the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS) announced a national plan to implement COVID-19 Test to Treat locations. The program implemented in January aligns with the National Test to Treat model. The early implementation is helping Puerto Rico to quickly increase the number of people tested for COVID-19 and rapidly getting those  who test positive and are eligible for COVID-19 therapeutics on treatment. Puerto Rico has expanded this model at Federally Qualified Health Centers, which are strategically positioned to serve vulnerable communities and now has a total of 17 Test to Treat locations.

The Test to Treat model was successful in Puerto Rico.  “We will continue expanding to provide time-sensitive treatments that people need when diagnosed with COVID-19. We are saving lives by providing immediate access to COVID-19 treatments at the same location where patients receive their positive results,” said Dr. Iris Cardona, Puerto Rico’s Chief Medical Officer.