According to data from the Centers for Disease Control and Prevention, COVID-19 has had a significant impact in American Indian and Alaska Native communities. Compared to non-Hispanic whites, American Indian and Alaska Native people have a higher cumulative COVID-19 incidence at 2.2 to 3.5 times; a higher cumulative COVID-19 mortality rate at 3.8 times; and a higher COVID-19 case fatality rate at 1.7 times.
On December 22, 2021, the U.S. Food and Drug Administration issued an emergency use authorization for Paxlovid® for the treatment of mild-to-moderate COVID-19 in certain adults and pediatric individuals 12 years of age and older weighing at least 40 kg, with positive results of direct SARS-CoV-2 testing, and who are at high risk for progression to severe COVID-19 , including hospitalization and death. Paxlovid® is a combination pharmacotherapy that has been found to be 89% effective in preventing serious COVID disease when given to outpatients soon after infection.
On March 2, 2022, the Biden Administration released the National COVID-19 Preparedness Plan , with four key goals, including to protect against and treat COVID-19. In coordination with this plan, on March 4, 2022, the U.S. Department of Health and Human Services issued a COVID-19 Test to Treat Initiative Fact Sheet outlining rapid ‘on the spot’ access to lifesaving COVID-19 treatments. Effective March 7, 2022, the HHS Coordination Operations and Response Element, or HCORE, began distributing oral antiviral pills directly to participating Test to Treat pharmacy-based clinics. In addition to the current allocation, HCORE is providing the Indian Health Service with a supplemental allocation of the oral antiviral, Paxlovid®, in support of an IHS COVID-19 Test to Treat Initiative.
The IHS, in collaboration with tribal and urban Indian partners, operates a national system of health care that combines access to laboratory, medical, and pharmacy services in tribal communities. In order to promote access to COVID-19 outpatient treatment and reduce the burden of COVID disease in the American Indian and Alaska Native population, the IHS has recruited over 50 test-to-treat pilot sites, representing a range of regions, facility types, and demographics. Sites have completed a self-assessment to demonstrate access to laboratory, medical, and pharmacy services, and the development of protocols to facilitate COVID-19 testing and outpatient treatment with Paxlovid®.
Best practices, including protocols developed by the pilot sites, are being leveraged to support recruitment of new IHS sites in the intermediate term, with the goal to scale up COVID-19 test-to-treat operations IHS-wide in the coming months.
More information about the IHS Test to Treat Initiative, including the site self-assessment and attestation process, as well as best practices developed by current pilot sites, may be accessed on the IHS National Pharmacy and Therapeutics Committee website.