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U.S. Department of Health and Human Services

Promising Practices

Providing Equitable Access to COVID-19 Monoclonal Antibody Treatments: Recommendations for Providers


This document includes promising practices and recommendations from several organizations working with communities affected disproportionately by COVID-19, that had success in increasing the utilization of COVID-19 monoclonal antibody treatments. These findings provide inspiration and information to those working to build treatment awareness and demand and can supplement individual plans and provide context to playbooks and planning discussions with leadership.

 
Summary

Communities of color and low-income communities were significantly and disproportionately more likely to be exposed to COVID-19, and more likely to experience infection, severe illness, hospitalization, and death attributable to the virus.1 This document describes the efforts of three organizations that worked to increase equitable access to COVID-19 monoclonal antibody treatment. These organizations implemented patient- and community-centered approaches to care, engagement, and problem solving. These approaches centered on compassion, deep knowledge of the communities they serve, and data-driven decision making to provide equitable access to care over the course of the COVID-19 pandemic.

Teche Action Clinics2 are a network of 16 Federally Qualified Health Centers (FQHCs) serving more than 25,000 patients across seven parishes in southwest Louisiana. The County of San Diego3 has 18 municipalities serving many diverse communities, including more than 3.3 million residents, 18 federally recognized tribal reservations, 16 major naval and military installations, and 64 unincorporated areas. The Black Coalition Against COVID4 was created to organize a multi-dimensional and broadly inclusive cohort of community leaders and advocates to urgently mobilize and coordinate assets to serve the Black community in Washington, D.C. and nationally.



Approach Overview

Organizations have used the following approaches to increase access to FDA-authorized monoclonal antibodies:

  • Establishedmaintained, and expanded trust through community building and gatekeeper engagement.
  • Amplified testimonials and strategic outreach—alongside critical data—to promote word-of-mouth conversations in the community.
  • Provided education in the context of each community’s specific needs to successfully implement patient-centered approaches to care.

Success Factors for Equitably Serving At-Risk Communities
During a Pandemic

  • Utilize a variety of communication platforms to saturate the community with information.
  • Validate and directly address the history of mistrust of medical systems in minority communities.
  • Leverage knowledge and trust from being a community member by centering testing and treatment plan development on social determinants of health.  
  • Employ data-driven decision making in all actions, recommendations, and collaborative efforts.



Recommendations

The following section provides key recommendations based on lessons learned by three organizations—Teche Action Clinics, the County of San Diego, and the Black Coalition Against COVID—as they served vulnerable populations during the COVID-19 pandemic.


Establish, Maintain, and Expand Trust Through Community Engagement

  • Leverage connections with a broad range of community leaders—including activists, artists, clergy, politicians and local officials, home healthcare providers, dentists, chiropractors, acupuncturists, and other trusted individuals and institutions in the community—to communicate about treatment options via trusted conduits.
  • Collaborate with organizations and individuals that explicitly prioritize care for minority, vulnerable, and underserved populations to subvert mistrust grounded in historical marginalization.
    • Some organizations had success working with medical schools and professional organizations specifically focused on Black, Hispanic, Native American, and Asian and Pacific Islander health.
  • Partner with long-standing, highly trusted institutions in their communities like FQHCs, home healthcare providers, Indian Health Service, and community-specific organizations to serve high-need populations.
    • Collaborate with local hospitals to support implementation of complex treatment and prevention pipelines.

Know Your Key Stakeholders and Community Gatekeepers

Stakeholders and gatekeepers are critical individuals in every community because they serve as decision-makers and deal-breakers on behalf of specific populations. The Teche Action Clinics successfully reached high need populations in part because they ensured that stakeholders had an opportunity to speak at critical junctures, and they consistently engaged gatekeepers like church leaders and local activists. The Black Coalition Against COVID enlarged their community-based grassroots campaign by collaborating with trusted organizations that could speak with both compassion and scientific credibility to the Black community. These organizations included historically Black college and university (HBCU) medical schools, the National Urban League, and the National Black Nurses Association, among others.

Exhibit 1: Stakeholders and Gatekeepers



Engage in Strategic Outreach that Amplifies Testimonials Alongside Data

  • Be strategic with outreach efforts to reach patients throughout their daily lives (or where they are).
    • Pay attention to who is considered a legitimate and trusted source of information in the community. Consider co-branded outreach and materials with trusted community institutions. 
    • Conduct outreach where people are, not just in healthcare organizations. Consider venues such as waiting, exam, and emergency rooms, as well as churches, community centers, shelters, and schools.
    • Implement public service announcement campaigns in collaboration with local radio stations, cable access television, church leaders, and elected officials.
    • Leverage point-of-contact events to give patients fliers and information about treatment eligibility.
  • Utilize personal testimonials from patients.
    • Houses of worship may give former patients opportunities to stand up and give testimonials about their experiences.
    • Post video testimonials on church, community center, school, and other social media channels for broader reach.  

Including Social Determinants of Health in Data-Driven Decision Making

Many organizations successfully used data to make decisions about which communities were highest risk and where to invest their limited resources. For example, the County of San Diego mapped infection rates by zip code, race, ethnicity, and age to identify where they needed to open regional centers providing easy access to mAbs treatment. This data-driven approach also informed their care practices: their treatment access centers utilized nurse triage lines, were open seven days a week, and were available to anyone regardless of health insurance, immigration status, or languages spoken.

Exhibit 2: Social Determinants Data to Drive Decisions



Education-In-Context is Key in Patient-Centered Approaches to Care

  • Understand your patients as individuals and as part of larger communities/cultures, including mistrust of health and medical organizations. Providers had good results with patients when they:
    • Acknowledged and addressed skepticism using data about treatment efficacy.
    • Highlighted influential members of communities of color involved in developing mAbs or vaccine technology.  
  • Provide information about treatment options in ways that meet your patients where they are, taking into consideration all the social determinants of health affecting your community.
    • Take a social work perspective by considering transportation, job, and childcare barriers to treatment. Ask patients if they have any logistical barriers that would prevent them from going to a site.
    • Provide new information in context of the patient’s lived experiences. For instance, older patients may understand the concept of herd immunity and antibody build-up based on their lived experiences with chicken pox in childhood.   



Conclusions and Resources:

Equitable access to care is challenging during the best of circumstances, and disparities in access to care were highlighted and exacerbated over the course of the COVID-19 pandemic.5 The practices and approaches employed by Teche Action Clinics, the County of San Diego, and the Black Coalition Against COVID were important and impactful in improving equitable access to care during a pandemic situation. However, the lessons learned and recommendations here may also apply for general provision of care in at-risk populations and communities.

All organizations highlighted in this document centered their care practices around deep-seated respect for different community cultures, norms, and perspectives.  Organizations should engage frequently and thoughtfully with key gatekeepers, focus on listening to understand pressing challenges, and keep historical context in mind as they collaborate with local leaders when they work on addressing health disparities in at-risk communities.



Resources:

  1. COVID-19 Racial and Ethnic Disparities (cdc.gov)
  2. Primary Care Health Clinic - Louisiana | Teche Action Clinic (tabhealth.org)
  3. Coronavirus Disease 2019 (sandiegocounty.gov)
  4. Black Coalition Against Covid – Fight COVID-19
  5. Racial and Ethnic Health Disparities Related to COVID-19 | Health Disparities | JAMA | JAMA Network
  6. Equitable Access to Monoclonal Antibody Treatment for COVID-19 (Video)

  • This page last reviewed: August 20, 2021