Primary Findings of Nationwide Home-based Test to Treat Program for COVID-19 and Influenza.

Importance: Timely initiation of antivirals for SARS CoV 2 and influenza depends on rapid diagnosis and access to prescribing. A national home based test to treat service was implemented to address these barriers. Objective: To evaluate reach, use, and timeliness of prescribing in the Home Test to Treat program. Design: Observational cohort analysis of program data from August 15, 2023 through April 17, 2024. Multivariable models assessed factors associated with test kit receipt, telehealth use and timing from symptom onset, antiviral prescribing and timing, and modality of medication fulfillment. Setting: Nationwide, remote program providing free at home tests, on demand telehealth, and oral antivirals with pharmacy pickup or home delivery. Participants: 66,169 adults who enrolled in the program and were eligible for analysis. Participation pathways included 1) proactive testing before symptoms, 2) on demand testing after symptom onset without a diagnosis, and 3) treatment only after a positive test. Exposures: Program pathway and participant characteristics, including insurance status and prior difficulties accessing care. Main Outcomes and Measures: Receipt of test kits, telehealth use and timing from symptom onset, and prescription of guideline directed oral antivirals within 1 day and within 5 days of symptom onset; choice of home delivery versus local pharmacy pickup. Results: Enrollees represented all 50 states and 891 of 896 three-digit ZIP Code areas. Proactive testers comprised 52.6%; 15.0% of the analytical sample reported a positive result. Among positives, 80.7% used the treatment only pathway; 83.2 percent chose telehealth and 76.3% of consults occurred outside local business hours. Antivirals were prescribed to 6,821 enrollees; 59.8% received oral antivirals within 1 day and 92.8% within 5 days of symptom onset. Prescribing within 1 day did not differ notably by age, insurance, race or ethnicity, or prior difficulty accessing care. Of those prescribed, 1,092 enrollees, 16.0%, selected home delivery rather than pharmacy pickup. Home delivery was more common among enrollees reporting more reasons for delaying care, difficulty accessing care, lacking insurance, or enrolled in Medicaid (P < .05). Conclusions and Relevance: Home Test to Treat delivered timely prescribing, including for adults with prior access barriers, by combining home based testing, on demand telehealth, and options for medication delivery across the country.