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Introduction

“Test-to-treat” is a concept of facilitating expedited access to treatment as soon as someone tests positive for a disease. In March 2022, the U.S. Health and Human Services Agency (HHS) initiated the "Test to Treat" program to make oral antiviral treatments more easily accessible throughout the country. 

Test-to-treat facilities are locations where individuals can get tested for COVID-19, speak to a health care provider about treatment options if they test positive, and leave with those treatments in-hand if they are eligible. These are crucial components to successful COVID-19 health care since most therapeutic options must be initiated as early as possible (usually within five to seven days of symptom onset) to be effective. By allowing patients to have a treatment prescribed and dispensed at the same location, the test-to-treat program saves valuable time for patients—especially for patients with limited mobility or modes of transportation – and reduces the chance of severe illness and hospitalization. With the advent of at-home antigen tests and telehealth, expedited access may include streamlined steps that take place outside of a physical provider office or clinic site.

Plans and providers should optimize workflows, processes, and communications to expedite each step of COVID-19 care delivery, particularly to prescribers and medication as at-home testing has become more accessible. In instances where providers have capability to dispense on-site, efforts should be made to link patients immediately to dispensing of therapeutics. Those sites that do not have mechanisms to dispense should provide linkages to pharmacies who can prioritize expedited prescription fulfillment and delivery. ​

The California Department of Public Health (CDPH) has been working with local health departments (LHDs) to add state-selected Test to Treat sites to the system. This initiative will not replace or impact the existing allocation system of therapeutics to California, and HHS will continue to distribute COVID-19 treatments, including oral antivirals, to California for distribution to jurisdictions. All qualified healthcare providers can still prescribe these therapeutics to patients who are at increased risk for developing severe COVID-19. HHS has created a Test-to-Treat facility locator that is available in English, Spanish, and Chinese. This site includes both federally and state supported locations.

Characteristics of Test to Treat Sites

Test-to-treat sites need to have three components: (1) rapid testing; (2) an available physician, advanced practice registered nurse, or physician assistant (these individuals must be able to prescribe outpatient medications for COVID-19); and (3) a CA Board of Pharmacy licensed pharmacist/pharmacy. While it is best for these elements to all be housed in the same facility, some co-located (or closely located) clinic and pharmacy pairs have created test-to-treat partnerships.

CDPH suggests that all Test to Treat sites have the following characteristics:

• Services provided to all individuals, regardless of insurance status or ability to pay.
• Comprehensive, end-to-end test and treat services to support a seamless patient experience.
• Either on-site rapid COVID-19 testing (result available at time of visit) or the ability to provide an evaluation of at-home test results.
• Health care providers available to provide timely and thorough assessments and discussions relevant to treatment option(s), consistent with FDA requirements of these medications.
• Co-located pharmacy that can readily dispense oral medications to eligible patients.
• A plan to refer patients to a provider or alternate location for infusion of IV remdesivir should oral medications be contraindicated.

Becoming a Test to Treat Site

Local health departments will be responsible for vetting additional test-to-treat facilities in their jurisdictions. Once vetted and identified, test-to-treat facilities can be labeled and uploaded to the Health Partner Ordering Portal (HPOP) and will appear on the HHS Test to Treat locator. Sites that would like to become a Test to Treat site should contact their LHDs.

Originally published on June 15, 2022