Assistant Professor and Director University of Massachusetts Medical School Worcester, Massachusetts, United States
Background: The federally sponsored Home Test-to-Treat (HTTT) program was developed to enhance timely COVID-19 testing and treatment access nationwide, especially beyond traditional business hours. Young adults (aged 18–25) represent a demographic that frequently requires flexible healthcare options due to scheduling barriers and limited access to in-person care. Objective: This study evaluates HTTT program outcomes for young adults, focusing on timeliness of telehealth and antiviral initiation, and examines factors associated with telehealth use outside standard business hours (9 AM – 5 PM). Design/Methods: We analyzed HTTT program data from young adults (N = 5,150), using multivariable logistic regression to assess factors associated with after-hours telehealth engagement, time from symptom onset to telehealth, and time to antiviral receipt. Subgroup analyses were conducted by age, race, gender, and insurance status. Results: Of the 3,350 young adults enrolled, 711 (2.12%) tested positive for COVID-19. Among those who tested positive, 581 (81.7%) accessed telehealth services, with 705 (78.8%) of these receiving antiviral prescriptions. Majority of the participants expressed uncertainty in being able to access care within 48 hours of need (60.4%) and delaying care despite needing it for either financial, geographical access, or timing constraints (73.9%). Notably, only 19.6% of telehealth engagements in the program occurred outside business hours and participants who reported barriers to receiving care had lower odds of starting telehealth during standard business hours (aOR: 0.80 [95% CI: 0.61-1.0]). Majority of participants (56.1%) who tested positive were prescribed antivirals within 1 day of symptom onset with participants with a history of delaying care due to barriers having increased odds of achieving this outcome (aOR: 1.40 [95% CI: 1.0 – 2.0]).
Conclusion(s): The federal HTTT program facilitated higher and more prompt antiviral access and after-hours telehealth engagement for young adults, demonstrating the potential of decentralized models to address both timing and accessibility barriers.
