Real-world data to evaluate effects of a multi-level dissemination strategy on access, outcomes, and equity of monoclonal antibodies for COVID-19

• Published in: Journal of clinical and translational science Vol. 7; no. 1; p. e258
• Main Authors: Hamer, Mika K, Sobczak, Chelsea, Whittington, Lindsey, Bowyer, Rachel L, Koren, Ramona, Begay, Joel A, Lum, Hillary D, Ginde, Adit A, Wynia, Matthew K, Kwan, Bethany M
• Format: Journal Article
• Language: English
• Published: England Cambridge University Press 2023
• Subjects: Advancing Translational Science through Real-World Data and Real-World Evidence; Cohort analysis; Communication channels; Community; COVID-19; dissemination and implementation; Drug dosages; Epidemiology; Health care access; Hospitalization; Implementation, Policy and Community Engagement; Monoclonal antibodies; Patients; Population; Public health; real-world effectiveness; Social networks; stakeholder engagement; United States > US; Colorado; COVID-19; real-world effectiveness; dissemination and implementation; stakeholder engagement; monoclonal antibodies
• ISSN: 2059-8661; 2059-8661
• DOI: 10.1017/cts.2023.679

Multi-level dissemination strategies are needed to increase equitable access to effective treatment for high-risk outpatients with COVID-19, particularly among patients from disproportionately affected communities. Yet assessing population-level impact of such strategies can be challenging. In collaboration with key contributors in Colorado, we conducted a retrospective cohort study to evaluate a multi-level dissemination strategy for neutralizing monoclonal antibody (mAb) treatment. Real-world data included county-level, de-identified output from a statewide mAb referral registry linked with publicly available epidemiological data. Outcomes included weekly number of mAb referrals, unique referring clinicians, and COVID-19 hospitalization rates. We assessed weekly changes in outcomes after dissemination strategies launched in July 2021. Overall, mAb referrals increased from a weekly average of 3.0 to 15.5, with an increase of 1.3 to 42.1 additional referrals per county in each post-period week ( < .05). Number of referring clinicians increased from a weekly average of 2.2 to 9.7, with an additional 1.5 to 22.2 unique referring clinicians observed per county per week beginning 5 weeks post-launch ( < .001). Larger effects were observed in communities specifically prioritized by the dissemination strategies. There were no observed differences in COVID-19 hospitalization rates between counties with and without mAb treatment sites. Real-world data can be used to estimate population impact of multi-level dissemination strategies. The launch of these strategies corresponded with increases in mAb referrals, but no apparent population-level effects on hospitalization outcomes. Strengths of this analytic approach include pragmatism and efficiency, whereas limitations include inability to control for other contemporaneous trends.