Early in the COVID-19 pandemic, monoclonal antibody (Mab) therapy was the only outpatient therapy for patients with COVID-19 experiencing mild-to-moderate symptoms. The Blocking Viral Attachment and Cell Entry with SARS-CoV-2 Neutralizing Antibodies (BLAZE-1) and the REGN-COV2 (Regeneron) clinical trials found participants treated with Mab had a shorter duration of symptoms and fewer hospitalizations compared with those receiving placebo.1,2 Mab therapy was most efficacious early in the disease course, and the initial US Food and Drug Administration (FDA) Emergency Use Authorization (EUA) of Mab therapies required use within 10 days of symptom onset.3
The impact of the COVID-19 pandemic has been felt disproportionately among marginalized racial and ethnic groups in the US. The COVID-19 Associated Hospitalization Surveillance Network found that non-Hispanic Black persons have significantly higher rates of hospitalization and death by COVID-19 compared with White persons.4-7 However, marginalized groups are underrepresented in the receipt of therapeutic agents for COVID-19. From March 2020 through August 2021, the mean monthly Mab use among Black patients (2.8%) was lower compared with White patients (4.0%), and Black patients received Mab 22.4% less often than White patients.7
The Mab clinical trials BLAZE-1 and REGN-COV2 study populations consisted of > 80% White participants.1,2 Receipt of COVID-19 outpatient treatments may not align with the disease burden in marginalized racial and ethnic groups, leading to health disparities. Although not exhaustive, reasons for these disparities include patient, health care practitioner, and systems-level issues: patient awareness, trust, and engagement with the health care system; health care practitioner awareness and advocacy to pursue COVID-19 treatment for the patient; and health care capacity to provide the medication and service.7
Here, we describe a novel, quality improvement initiative at the Atlanta Veterans Affairs Health Care System (AVAHCS) in Georgia that paired a proactive laboratory-based surveillance strategy to identify and engage veterans for Mab. By centralizing the surveillance and outreach process, we sought to reduce barriers to the Mab referral process and optimize access to life-saving medication.