Barriers in COVID-19 Oral Antivirals (OAVs) in Long Term Care Facilities: A Clinical Perspective to Inform Future Collaboration

Introduction: An article published in JAMA in August 2023 highlighted a list of 15,438 nursing homes analyzed by the Center for Medicare and Medicaid Services (CMS). Of that total list, 5,705 were “never used facilities,” which refers to nursing homes identified in a recent JAMA Network Research Letter * as not having oral antiviral or monoclonal antibody use. Methods: During seven weeks from October 1 to November 17, 2023, a five-member team from HHS Coordination and Operations Response Element (H-CORE) Operations Technical Assistance (OpTA) Division – including three nurses, one science analyst, and one physician assistant – surveyed all 5,705 “never used facilities ”. They gathered information on knowledge of the COVID-19 therapeutics Paxlovid and Lagevrio, accessibility in obtaining Paxlovid and Lagevrio from pharmacies or other entities, and hesitation from residents or providers/clinical staff in the use of Paxlovid and Lagevrio. Results: Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities. Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities. Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities. Conclusion: Supporting outreach initiatives by continuing collaboration with local/state health departments to vulnerable populations by disseminating specifically targeted information will help contribute to equitable access to care.