Agenda6:00 – 6:10 PM: Welcome and Introductions6:10 – 6:25 PM: Overview of Antiviral Medications for COVID-196:25 – 6:40 PM: Access and availability of oral antivirals6:40 – 6:55 PM: Models to Provide Access to Oral Antivirals in Boston and Challenges6:55 – 7:25 PM: Discussion7:25 – 7:30 PM: Next Steps and Closing

Samantha Taylor, Executive Director, Bowdoin Street Health Center

Thank you for joining us today! Please let us know who’s in the room by sharing your name and organization here in the chat.

Rachel Wilson, President, CIC Health

Christine Farrell-riley Codman square health center

Eduardo Nettle MA DPH, Vaccinine Equity Initiaitve Community Liaison/Boston

Julie Levison, ID physician MGH Chelsea HealthCare Center

Bernie Jones, VP Value-Based Care and Public Policy, Brigham and Women’s Hospital

Sebastian Hamilton, chief pharmacy officer ambulatory pharmacy services, Boston Medical Center

Sara Turley, Chief of Staff, CIC Health

Howard Gold, MD BIDMC/BILH

Melissa Leaston, Director of Nursing

Alyssa Ring, Director of Government Affairs, Beth Israel Lahey Health

Jonathan Pincus Primary MD- Codman Square Health Center and Harbor Health Services

Whittier Street Health Center

Julia Raifman, ScD, Boston University School of Public Health

Marjorie Janvier, Clinical Director Adult Medicine, The Dimock Center

Camille Kotton, transplant ID at MGH

Elissa Perkins, Emergency Medicine physician and Director of Emergency Department Infectious Disease Management, BMC

Lara Jirmanus, MD MPH, Cambridge Health Alliance SDOH Provider Lead

Leigh Simmons, primary care internal medicine at MGH

Tish McMullin, Conference of Boston Teaching Hospitals

Liana D’Elia, RN, MGH Chelsea Adult Medicine

Is there any concern that BA.1.1 has any different response to mAbs than BA.1?

Howard, not for the therapeutic monoclonals but yes for Evusheld

Given limitations of infusions at many sites can you comment on IM Sitrovimab. While “non inferior” there were more admissions and deaths in the IM arm.Can we reuse the extra nirmatrelvir from patients with CKD and repackage it with ritonavir to expand access?

what is availability of Paxlovid?

Thanks Larry. That's what I thought you said yesterday. Can you cite a reference?

Howard, excellent twitter thread from Jon Li at BWH https://twitter.com/drjli/status/1487479972293853188

Thank you!

https://mdphgis.maps.arcgis.com/apps/instant/nearby/index.html?appid=82983fa9f6d44e2aaf1d5bd420aa57ff

Are physicians discussing treatment with patients individually, regarding risk profile of molnupiravir at Gothams?

What are the primary drivers for the current dispensing rates of available doses?

@Larry that’s a very helpful map - here’s the national version (I found helpful for a pt in Florida) https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

Thanks Dylan. Great talk.

Great and thorough information on efficacy of oral agents, roll out plans for high risk to low, supply + accessibility of agents, etc. One major barrier we experienced was community uptake/acceptance of therapy in the very communities hardest hit + high SVI. Was there any anticipation or planning for PSA + community education before agents became available to help with patients agreeing to oral therapy?

I agree more communication would be very helpful.

It would be good to learn best practices across the community health centers (who have clearly effectively rolled this out thus far)-- that could teach those of us about to do this at AMC-licensed health centers.

On the primary care end, the tiered recommendations of who should be prescribed which medications in which order, while is helpful can also confuse the process. I.e. As we only order one medicine at a time and how much of which is available, it seems like we should be ordering nirmatrelvir/ritonavir until supply runs out.

Community health centers could do a better job communicating with each other and with public health authorities, but more resources would be helpful for this…

This question is for the prior speaker — I wonder how you’re preparing for the next surge? Specifically ensuring that people from vulnerable populations have a supply of tests to quickly diagnose cases and reach providers during high demand periods? I appreciated this article on the highest risk people being least likely to access monoclonal antibodies. https://jamanetwork.com/journals/jama/fullarticle/2788904

Thank you so much! Would love to know if East Boston had 1 treatment option or multiple? And any preliminary feedback from patients about their experience with the meds? Lastly any race/ethnicity data on the patients who received the meds at East Boston

How do you manage patients who meet criteria and report a home antigen test that is positive

Are any other state testing sites (not clinic-affiliated) providing information about antivirals and how to access if +?

I wonder if a public education campaign about the importance of prompt treatment, and in several languages, may also be helpful? Perhaps it could be combined with information on the importance of vaccines & boosters

Agree, Julia!

Same, several patients very pleased with outcome

Agree with Julia suggestion

How does DPH plan to disseminate the information about patient self referral for treatment?

Is there a budget for marketing?

One of the barriers in accessing Mabs for pts from some of our vulnerable communities (esp given high rates of comorbidities and potential drug interactions in complex pts) has been transportation to Mab sites. Are there state-wide efforts on this front (in addition to having sites closer to these communities as you are doing)?

Jackie,fantastic roll out!

Thank you for sharing. Will there be mass media campaigns as well?

Great news on flyers, thank you.

The flyers on vaccines are great but hearing many patients have not seen them on the website

Good point from Dr Hurtado…

@Rocio, I had a pt who got mAb at home via Cataldo. wondering how often that can happen and if for everyone?

Is there a strategy for treating unsheltered individuals ?

https://drive.google.com/file/d/1ksdNitC1_U7PXM5qmBAIsXJitwyfmpwU/view

Agree with Melissa Leaston - homeless and other marginalized populations need a priority…

The above link was the flyer shared regarding patient self referral

Should we consider a multilingual workforce (hotline) who can answer You’re positive now what? And connect people to options and treatment

That’s a great idea to have a hotline

It would also be nice for a DPH dashboard tracking supply of therapeutics. As providers don’t know which sites have how much of what med prior to prescribing.

That's is a great idea

Huge issue

How is the state preparing for the next surge and ensuring vulnerable populations have good access to rapid tests?

^^^

The website actually lists the availability of each therapeutic at each site if you click on them

Agree with the importance of getting treatment information out to patients...Information at testing sites etc.. to help facilitate

@Rocio Gothams is able to arrange for transport to the Gothams site for patients that cannot arrange transport on their own

At MGB we have offered hospital based, CHC based and mobile (van) and continue to find that awareness about the meds and their time sensitivity remains. A proactive outreach to those who are eligible and test positive combined with an easy line for those who test at home (and don’t have a PCP) would be great to increase equity

Agree with Julia Raifman - preparing for the next surge - particularly regarding budgets, workplans, helping the homeless/ marginalized etc.

Great suggestion

Will the mgb vans have the med on the van?

I like the idea of distributing information about the treatment with the test kits.

A big concern is reaching people WELL before infection - so that they know to reach out for help if they get sick, and don't miss the treatment window. It's going to need a real change in messaging from our earliest days of not having treatments.Any models out there yet of outreach to unvaccinated patients specifically, to make sure they know to reach out early if unwell?

Agree with Leigh. We have lots of patients with low health literacy.

Agree with Eduardo Nettle regarding trust.

Philip - problem of not knowing about this (or thinking that the treatments remain completely unavailable) is really pretty widespread. I've had patients who were very surprised to hear that I was recommending a treatment - and glad to receive one - but the messaging is just not getting out there well enough yet.

Thank you BPHC for bringing us together and great presenters.

So glad you’re planning for surges

Agree with Julia Raifman. And Dr Ojikutu regarding paid sick leave, equity.

Yes thank you for highlighting the importance of paid leave, Dr. Ojikutu

Electronic billboards?

Agree with the importance of messaging to marginalized communities in Dorchester, Roxbury, Mattapan, Brockton, etc.Thanks for a great session tonight to Drs Ojikutu, Gandhi, Tierney and others.All hands on deck!

Would like to echo the paid sick leave. Thank you Dr. Ojikutu. Unfortunately the governor’s address on masks in schools and messaging that COVID is mild makes it difficult for us to appropriately communicate risk to patients (and benefits) of new treatments.

Agree, be great to be more intentional and proactive about creating patient demand

Agree with Dr Jirmanus regarding masks.

Truly appreciate the work you have done and thank you for bringing us together DPH and BPHC

Yes important for the federal government to do medication and vaccine information campaigns in many languages

Would be helpful to reach out to community based organizations for advice and input

Great presentation.

thank you for this helpful presentation!

This was very helpful. Thank you.

Thank you! Excellent.

Thank you so much for bringing us together, DPH and BPHC. This was excellent!

Thank you— it would be great to get slides / recording

Thank you. This presentation was very informative and clear.

Thank you! Really appreciate your leadership

Agree thank you!

A new culture of collaboration in public health, infectious disease and community based care for the most marginalized. Love it. Thanks- we can bring the coalitions to the table.