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Healthcare disparities in the US have become strikingly apparent throughout the COVID-19 pandemic, affecting historically underserved populations (e.g., lower-income households, Black and Minority Americans, immigrants, people with disabilities, rural populations, etc.). Point-of-care (POC) testing can help. To reduce the spread of infections and bring health equity forward, we need to take a closer look at POC testing and how to get it to communities that need it most.

Healthcare disparities in the US at the point of care

The rapidity of spread and mortality associated with the COVID-19 pandemic has shined a light on health disparities in the US. COVID-19 infection is higher among groups already affected by health disparities across age, race, ethnicity, language, income, and living conditions.1 Since the beginning of the pandemic, the top-third of vulnerable counties (defined by the COVID-19 vulnerability Index) have seen 21% more cases and 47% more deaths than the bottom-third of vulnerable counties, despite receiving 27% fewer tests.2 3

One study found that transportation barriers are associated with significantly higher odds of a positive COVID-19 test, which suggests a greater risk of disease exposure associated with reliance on public transit and/or shared rides, or it may suggest inadequate access to health care, including timely COVID-19 testing.1 What’s more, COVID-19 has shifted the utilization of the American healthcare system where individuals are delaying or forgoing care—which can have serious and life-threatening health consequences. By June 2020, over 40% of U.S. adults reported that they delayed health care due to COVID-19 concerns.4

Adding to these challenges is the threat of false negative COVID-19 test results, which could potentially lead to positive case clusters.5 6 When false negatives are suspected, individuals have to leave the facility and wait for their reflex testing results to become available. Ideally, individuals awaiting reflex testing results (as well as those who receive a positive COVID-19 test result) will quarantine, but this is not always possible, especially for those relying on public transportation and living in overcrowded housing facilities.

Minimizing the time it takes to get accurate results and being able to communicate those results to patients quickly is paramount for minimizing community spread and delivering proper treatment. This supports the need for rapid and reliable testing, as well as in-visit test-to-answer POC workflows—especially for communities that have been shown to have less access to medical care and are less inclined to use telehealth service.

What Point-of-Care Diagnostic Tests Should Look Like

To drive health equity forward, we need diagnostic testing to be more accessible and reliable for underserved populations.

Point-of-care diagnostics should enable rapid and effective test-to-treat workflows all in one visit

Because underserved populations are more likely to miss appointments due to transportation and are more likely to have limited access to telehealth,7-10 it is imperative that these individuals get the information and treatment they need while they are in the testing facility. To confidently make treatment decisions during the same visit, point of care diagnostic tests should be sensitive without compromising speed and operational efficiency.

Not only will test-to-treat workflows at the point of care help detect disease and deliver proper care earlier, but it can help minimize health care expenses due to missed appointments and hospitalization. This approach is stressed in the Sexually Transmitted Infections National Strategic Plan (2021-2025), where several objectives are discussed to ensure continuity of care. The plan touches on expanding personnel training to enhance screening, testing, and treatment capabilities within a single facility, specialized programs, and integrated and collaborative approaches in settings that serve communities disproportionately affected by STIs, HIV, and viral hepatitis.11

The Talis Solution: A sample-to-answer test with central-lab quality sensitivity

  • The Talis One COVID-19 test enables quick and secure collection of samples for infectious disease testing
  • Talis One provides lab-quality molecular diagnostic results by utilizing innovative nucleic acid amplification technology integrated with solid-phase nucleic acid purification
  • Compared with up to several days of wait time for lab-run tests with similar accuracy, the Talis One solution delivers clear results in less than 30 mins

Point-of-care diagnostics should be flexible enough to adapt to different environments and different communities

Point-of-care locations can range from large pop-up centers in rural areas and places of work to metropolitan mobile clinics. Each community is unique, and POC tests need to be adaptable to the specific needs of the community. The instruments being used to detect SARS-CoV-2 should be space efficient for multiple types of facilities and, ideally, flexible enough to test for multiple infectious diseases and disease variants that are prevalent in the community being tested. This can save time for both the individual and the testing facility.

As suggested by the Office of the Assistant Secretary of Health (OASH) and Office of Minority Health (OMH), to expand access to communities that are unable to access traditional testing sites, the federal government should partner with test kit manufacturers to develop SARS-CoV-2 test kits that are flexible enough to be used at the point of care or at-home and should establish and enforce policies that require public and private health insurance to cover SARS-CoV-2 testing to minimize financial barriers.12

The Talis Solution:

  • Talis One is a complete, cost-effective solution that has potential for menu expansion to infectious diseases in respiratory and women’s health
  • With its small footprint and streamlined sample-to-answer workflow, Talis One can be used in a variety of point-of-care settings, enabling easy and broad access to testing for patients

Point-of-care diagnostics should be easy-to-implement and easy-to-use

Adopting new healthcare technologies is resource intensive—requiring a substantial amount of time for implementation and training. With healthcare personnel shortages increasing in underserved areas,13 it can be difficult to maintain an efficient operational workflow, or worse, patients cannot get the tests they need because there aren’t enough people to perform them. POC testing needs to be easy to implement and intuitive so that facilities can get up and running as quickly as possible and maintain efficiency through personnel changes.

The Talis Solution:

  • Talis One’s user-centric workflow makes it easy to quickly begin testing in a variety of CLIA- waived healthcare settings
  • Talis provides on-demand support and training including access to educational resources and implementation guides

Point-of-care diagnostics should have features that streamline reporting and communication to patients, labs and governing bodies

Timely reporting is essential for sharing results, monitoring where outbreaks occur, tracking the incidence and prevalence of infection, and evaluating the impact of interventions. Not only can it help determine if a newly placed mobile clinic is effective and quickly get test results to patients, but it also enables proper allocation of critical resources to those in greatest need.

The Talis Solution:

  • Talis One has cloud connectivity that easily integrates with LIS and EMR systems
  • Results from the Talis One molecular tests are delivered as easy-to-understand reports
  • With sample-to-answer workflow, Talis One enables caregivers to communicate results to patients within 30 minutes

Moving Towards Health Equity with Point-of-Care Testing

With the CDC planning to invest $2.25 Billion to address COVID-19-related health disparities and advance health equity among populations that are at high-risk and underserved,14 there is no better time than now to evaluate and adopt a new POC testing solution.

To ensure there is timely and equitable access to testing with rapid return of results in communities disproportionately affected by COVID-19, we need to consider the recommendations outlined by the CDC:1 5

  • Use a social vulnerability index16 to help select testing sites
  • Review the groups to prioritize for screening testing
  • Carefully consider the different types of SARS-CoV-2 tests when planning for diagnostic or screening use

By providing easy access to actionable results at the point-of-care in public health settings, the Talis One molecular testing solution empowers you to quickly and confidently diagnose infections, promote safety and peace of mind for your patients, and ultimately combat healthcare disparities in the US.

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References

  1. Rozenfeld, Yelena, et al. “A model of disparities: risk factors associated with COVID-19 infection.” International journal for equity in health 19.1 (2020): 1-10.
  2. Bringing Greater Precision to the COVID-19 Response. (2020, December). Retrieved July 01, 2021, from https://precisionforcovid.org/ccvi
  3. Smittenaar, P., Stewart, N., Sutermaster, S., Coome, L., Dibner-Dunlap, A., Jain, M., … & Sgaier, S. K. (2021). A COVID-19 Community Vulnerability Index to drive precision policy in the US. medRxiv.
  4. Czeisler, Mark É., et al. “Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020.” Morbidity and mortality weekly report 69.36 (2020): 1250.
  5. False negative rate of COVID-19 PCR testing: A discordant testing analysis. (2021, January 9). Retrieved July 01, 2021, from https://virologyj.biomedcentral.com/articles/10.1186/s12985-021-01489-0
  6. Cao G, Tang S, Yang D, Shi W, Wang X, Wang H, et al. The potential transmission of SARS-CoV-2 from patients with negative RT-PCR swab tests to others: two related clusters of COVID-19 outbreak. Jpn J Infect Dis. 2020. https://doi.org/10.7883/yoken.JJID.2020.165.
  7. Samuels, R. C., Ward, V. L., Melvin, P., Macht-Greenberg, M., Wenren, L. M., Yi, J., … & Cox, J. E. (2015). Missed appointments: factors contributing to high no-show rates in an urban pediatrics primary care clinic. Clinical pediatrics, 54(10), 976-982.
  8. Fischer, S. H., Ray, K. N., Mehrotra, A., Bloom, E. L., & Uscher-Pines, L. (2020). Prevalence and characteristics of Telehealth utilization in the United States. JAMA network open, 3(10), e2022302-e2022302.
  9. Pierce, R. P., & Stevermer, J. J. (2020). Disparities in use of telehealth at the onset of the COVID-19 public health emergency. Journal of telemedicine and telecare, 1357633X20963893.
  10. Vogels, E. (2021, June 22). Digital divide persists even as Americans with lower incomes make gains in tech adoption. Retrieved July 01, 2021, from https://www.pewresearch.org/fact-tank/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/
  11. U.S. Department of Health and Human Services. 2020. Sexually Transmitted Infections National Strategic Plan for the United States: 2021–2025. Washington, DC.
  12. COVID-19 Health Equity Task Force: Long COVID, PPE, Testing and Therapeutics Subcommittee Interim Recommendations. (2021, June 25). Retrieved July 01, 2021, from https://www.minorityhealth.hhs.gov/Assets/PDF/June-COVID19HETFSubcommitteesRecommendations-062521-508.pdf
  13. Malayala, Srikrishna Varun, et al. “Primary care shortage in medically underserved and health provider shortage areas: Lessons from Delaware, USA.” Journal of Primary Care & Community Health 12 (2021): 2150132721994018.
  14. CDC announces $2.25 billion to address Covid-19 health disparities in communities that are at high-risk and underserved. (2021, March 17). Retrieved July 01, 2021, from https://www.cdc.gov/media/releases/2021/p0317-COVID-19-Health-Disparities.html
  15. Overview of Testing for SARS-CoV-2 (COVID-19). (2021, March 17). Retrieved July 01, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
  16. CDC/ATSDR Social Vulnerability Index. (2021, April 28). Retrieved July 01, 2021, from https://www.atsdr.cdc.gov/placeandhealth/svi/index.html

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