Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Pre-Exposure Prophylaxis: Experience from a Single Medical Center

Keith W Hamilton,Elvis Hua,Lauren Dutcher,Holly Fernandez Lynch,Paul Junker,Abigail G Doucette,Danielle Werner,Ethan Z Kannel,Thomas Civitello,Peter Gabriel,Vivek N Ahya,Dina A Jacobs,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,Pablo Tebas

doi:10.1093/ofid/ofae388

Abstract

Abstract Background During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for pre-exposure prophylaxis (SMA-PrEP) offered immunocompromised patients another option for protection. However, SMA-PrEP also posed administrative, operational, and ethical challenges for healthcare 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 scarcity of resources, our hospital was able to administer at least one 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. Compared to patients who identified as Black, patients who identified as White (odds ratio [OR] 1.85, 95% confidence interval [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. Compared to 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 healthcare disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.

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