Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Preexposure Prophylaxis: Experience From a Single Medical Center
Document Type
Article
Publication Date
7-10-2024
Abstract
Background
During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for preexposure prophylaxis (SMA-PrEP) offered patients who were immunocompromised another option for protection. However, SMA-PrEP posed administrative, operational, and ethical challenges for health care facilities, resulting in few patients receiving them. Although the first SMA-PrEP medication, tixagevimab and cilgavimab, had its authorization revoked due to compromised in vitro efficacy, new SMA-PrEP medications are currently completing clinical trials. This article provides an operational framework for administrative organization, patient identification and prioritization, equitable medication allocation, medication ordering and administration, and patient tracking.
Methods
A retrospective cohort study evaluating our hospital's SMA-PrEP administration strategy was performed. Multivariable logistic regression was used to examine factors associated with receipt of SMA-PrEP. Results Despite the barriers in administering this medication and the scarcity of resources, our hospital was able to administer at least 1 dose of SMA-PrEP to 1359 of 5902 (23.0%) eligible patients. Even with the steps taken to promote equitable allocation, multivariable logistic regression demonstrated that there were still differences by race, ethnicity, and socioeconomic status. As compared with patients who identified as Black, patients who identified as White (odds ratio [OR], 1.85; 95% CI, 1.46–2.33), Asian (OR, 1.59; 95% CI, 1.03–2.46), and Hispanic (OR, 1.53; 95% CI, 1.02–2.44) were more likely to receive SMA-PrEP. When compared with patients with low socioeconomic status, patients with high socioeconomic status (OR, 1.37; 95% CI, 1.05–1.78) were more likely to be allocated SMA-PrEP.
Conclusions
Despite efforts to mitigate health care disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.
Additional authors: Alfred Garfall, Keith Pratz, Kathleen O. Degnan, Emily A. Blumberg, Donna Capozzi, Ethan Craig, Patricia Takach, Aimee S. Payne, Abdallah Geara, Helen Koenig, Lawrence Holzman, and Pablo Tebas
Keywords
allocation, COVID-19, disparity, preexposure prophylaxis, SARS-CoV-2 monoclonal antibodies
Publication Title
Open Forum Infectious Diseases
Repository Citation
Lynch, Holly Fernandez; Hamilton, Keith W.; Hua, Elvis; Dutcher, Lauren; Junker, Paul; Doucette, Abigail G.; Werner, Danielle; Kannel, Ethan Z.; Civitello, Thomas; Gabriel, Peter; Ahya, Vivek N.; and Jacobs, Dina A., "Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Preexposure Prophylaxis: Experience From a Single Medical Center" (2024). Articles. 458.
https://scholarship.law.upenn.edu/faculty_articles/458
https://doi.org/10.1093/ofid/ofae388
DOI
https://doi.org/10.1093/ofid/ofae388