Nationwide Home Test to Treat program offers combined COVID-19 and flu test, telehealth, and treatment

The COVID-19 pandemic has fundamentally reshaped healthcare, with telehealth emerging as a vital tool for delivering crucial services to patients from the comfort and safety of home.

Now, a groundbreaking new program takes this a step further in the expansion of the Home Test to Treat, an entirely virtual community health initiative offering free at-home rapid tests for COVID-19 and the flu, as well as telehealth consultations, and medication delivery for eligible participants nationwide.

This initiative, a collaboration between the National Institutes of Health (NIH), the Administration for Strategic Preparedness and Response (ASPR), and the Centers for Disease Control and Prevention (CDC), marks a significant leap forward in accessible and convenient healthcare.

According to Andrew Weitz, Ph.D., program officer at the National Institute of Biomedical Imaging and Bioengineering, who leads the Home Test to Treat program for the NIH, Home Test to Treat was inspired by the Administration for Strategic Preparedness and Response (ASPR) “brick and mortar” test-to-treat program.

“Home Test to Treat was designed to overcome these challenges by leveraging novel technologies such as over the counter (OTC) tests, telehealth, and online pharmacies,” Weitz said.

The challenges he refers to are the following:

Onset of symptoms

• Medications are designed to be started within 5 days of symptoms
• Need proof of SARS-CoV-2 positivity for treatment, and OTC tests are often not accepted

Find and travel to a Test to Treat facility

• Large areas of the country do not have a nearby facility
• Difficulty for sick and disabled to travel to a facility
• Difficulty in obtaining same-day appointments, especially as demand increases during pandemic spikes
• Trip to facility creates risk of viral transmission to public

Consultation with healthcare provider to obtain prescription

• Difficulties in consultation scheduling

Obtaining medication

• Pharmacies often carry one of the two antivirals, and individuals needing a specific drug due to contraindications may have to travel outside of their community
• Clinics and pharmacies must be under same roof, a setup that doesn’t exist in many regions
• Facility-based programs may overburden the workforce that is also administering testing and vaccinations

In an announcement made by the NIH last month, the program is open to any adult 18 years and older that has received a current positive test for COVID-19 or the flu. They can enroll to receive free telehealth, and if prescribed, have medication delivered directly to their home.

Adults who do not have COVID-19 or the flu can enroll in Home Test to Treat to receive free tests if they are uninsured or enrolled in Medicare, Medicaid, the Veterans Affairs system, or Indian Health Services. If they receive a positive test in the future, they will receive free telehealth care, and if needed, treatment.

Weitz said thus far 43,200 people have enrolled in the program as of Jan. 12, 2024.  Nearly 30,000 of these individuals have received tests from the program, and more than 4,500 have received telehealth services. A large proportion are medically underserved individuals. 

“We have heard some success stories from program participants, including an individual who tested positive for covid when they weren’t in their home state and needed Paxlovid right away.  They were able to get it very quickly through the program,” he said.

“Also, an individual who needed care over the weekend, and they were unable to contact their primary care provider. They were able to get care nearly immediately through the program.”

Poised to revolutionize the telehealth landscape

This project is breaking new ground as the first public health program to integrate home testing technology at such a scale for both COVID-19 and flu. This removes barriers to early diagnosis and empowers individuals to take control of their health.

Home Test to Treat offers broader protections with the potential to reduce the burden on healthcare systems. Plus, for patients in rural communities or with limited transportation, it allows them access to testing, consultation, and medication (if prescribed) from the comfort of their own homes.

This project has the potential to help address critical needs:

• Equity in Healthcare: The program prioritizes access for disadvantaged communities by offering free services to uninsured individuals and those enrolled in government healthcare programs. This helps bridge the digital divide and ensures equitable access to essential healthcare services.
• Time is of the essence: For conditions like COVID-19, early treatment is crucial. Home Test to Treat enables diagnosis and treatment initiation within a critical window, potentially improving patient outcomes.
• Continuity of care: The program emphasizes seamless transitions between testing, consultation, and treatment, reducing the risk of delays or missed steps.

Weitz added that eMed provides a technology platform that participants can use to order tests, report test results, receive telehealth sessions, and get treatment. 

“The platform was customized for this program to provide easy and seamless transitions between the testing, consultation, and treatment functions. Once users register for the program, they access the platform by logging in through test2treat.org.”

Public health game changer

Research is an important aspect of this project. Home Test to Treat is part of the National Institute of Biomedical Imaging and Bioengineering’s Rapid Acceleration of Diagnostics (RADx®) Tech program, which has identified the benefits for patients and factors that are crucial to broad adoption of home test to treat services beyond COVID-19 and the flu. NIBIB’s mission is to improve health by leading the development and accelerating the application of biomedical technologies.

RADx, launched on April 29, 2020, to speed the development for COVID-19 testing. The initiative has four programs: RADx Tech, RADx Advanced Technology Platforms, RADx Underserved Populations and RADx Radical. The test used in Home Test to Treat is the Pfizer COVID-19 & Flu Home Test, which is the first U.S. Food and Drug Administration (FDA) approved test that can detect both viruses at the same time.

Weitz said the program has been successful in improving accessibility to healthcare by disproportionally engaging with underserved populations. The program is available in English and Spanish, and patients who don’t have a computer, smartphone or internet access can participate through a toll-free number (1-800-682-2829)

“Learnings from this program will inform future public health programs in areas such as: How do public health programs quickly and most effectively reach underserved individuals who need these types of healthcare services the most?  How can virtual programs like this reduce time from symptom onset to treatment, while reducing risk of viral transmission to the public?  How can we leverage novel technologies such as home testing and telehealth to reduce burden on physical healthcare settings?”

The program’s early success stories don’t necessarily mean it will return next flu season. Weitz said two of biggest challenges may be funding and public interest. 

“Scaling a program like this can get expensive, and that could require sustained support from the government. Public interest in the program has waxed and waned as levels of respiratory virus transmission have waxed and waned. For example, when COVID-19 levels are low, media attention is low, and we see relatively little interest in the program,” he said.

“During times when COVID/flu transmissions are high, interest spikes. Scaling would be difficult at times when there is relatively little interest in the program. It could be especially difficult for the private sector to maintain a program like this if the revenue stream is so variable.”

There are solutions that remain available outside Home Test to Treat. Weitz said for access to Paxlovid, the U.S. government patient assistance program operated by Pfizer provides free Paxlovid to Medicare, Medicaid and uninsured patients, and a Pfizer co-pay savings program reduces the cost of the treatment for people who have commercial insurance so that these patients have no-cost or low-cost treatment.

In addition, free Paxlovid is available this year through certain U.S. government programs that provide patient care, such as HRSA-funded health centers, Indian Health Services, and the Veterans Administration. For Lagevrio, MerckHelps assists patients who otherwise could not afford this treatment, and there’s also a patient support program.