1108. Feasibility and Impact of a Monoclonal Antibody Infusion Program in Reaching Vulnerable Underserved Communities

Abstract

Background Monoclonal antibodies (mAbs) against SARS-CoV-2 are potent therapeutics that prevent progression of disease in high-risk patients. Deploying mAb infusion programs and reaching communities in need remains challenging. We established a mAb infusion program centered in the emergency department (ED) fast-track. We seek to assess the feasibility and impact of our mAb infusion program in reaching vulnerable underserved communities. Methods The ED fast-track was repurposed for mAb infusions. Indications and protocols were created by the infectious disease (ID) physician and antimicrobial stewardship program (ASP). Test to treat was deployed in the ED and a referral program connected patients from telehealth and providers in the community to the infusion program (Figure 1). Data on mAb use from November 2020 to February 2022 was reviewed. To assess the reach of the program in vulnerable communities, the COVID-19 Community Vulnerability Index (CCVI) map by zip code was used. The CCVI identifies communities at risk by using variables such as sociodemographic variables, occupational factors, cumulative COVID-19 burden, vaccine uptake and other factors. Figure 1.Monoclonal antibody infusion test-to-treat and referral process in the ED fast track Results mAbs were successfully deployed and sustained throughout the pandemic, increasing its use in each COVID-19 surge by >103% (Figure 2). A total of 267 patients were treated, with an average age of 52 years, of which 55% (147) were female. Ethnicity was 46% Hispanic and Race was 54% White, 28% Black, 1.4% Asian, 1.8% Multiracial and 14% Other. Zip codes by CCVI were 64% high, 18% medium, and 3% low CCVI index. 15% were outside of city limits without CCVI index (Figure 3). Figure 2.COVID-19 Community Vulnerability Index (CCVI) of patients who received monoclonal antibodies at our program Figure 3 Monoclonal antibody infusions by COVID-19 Community Vulnerability Index (CCVI) and Zip codes Conclusion A mAb infusion program with test to treat and referrals from the community was successfully deployed in an ED fast track. The ED space and staff can be leveraged for mAbs during surges amid clinic staffing challenges. The program adopted novel mAbs as new COVID-19 variants emerged. Uptake increased with each wave, likely reflecting awareness of mAbs and the infusion program by patients and providers in the community. The majority of patients served (82%) were of high and medium CCVI. Thus, this mAb infusion program led by ID and ASP successfully reached predominantly underserved vulnerable populations. Disclosures All Authors: No reported disclosures.

Advancing health equity through action in antimicrobial stewardship and healthcare epidemiology

“…10 More than 70% of US hospitals have <200 beds, and many of these facilities serve communities in need and those from minoritized communities. 11,61 Inclusive cultures must be developed and fostered during health professions training and patient care, 43,45,62 as well as through intentional assembly of healthcare epidemiology-infection prevention-antimicrobial stewardship teams to include intersectional identities. Unconscious or implicit bias describes "associations or attitudes that reflexively alter our perceptions, thereby affecting behavior, interactions, and decision making," 63 and can contribute to inequities in antimicrobial stewardship.…”

“…They leveraged an emergency department fast-track location and existing staff to make the treatment available for an underserved community. 11 Sustainable measures to mitigate disparities require accountability. Public and private institutions, including societies dedicated to healthcare epidemiology and antibiotic stewardship, have made public declarations of diversity equity and inclusion commitments.…”

“…10 More than 70% of US hospitals have <200 beds, and many of these facilities serve communities in need and those from minoritized communities. 11,61…”

“…They leveraged an emergency department fast-track location and existing staff to make the treatment available for an underserved community. 11…”

“…1 Infection risk in health care and quality of antibiotic use vary by patient population. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Thus, opportunities exist for education and awareness about health equity and how it applies to infectious diseases, healthcare epidemiology, and antimicrobial stewardship. To underscore the importance of preparing the healthcare workforce to understand, recognize, and respond to health inequities, Uehling et al 18 asked >200 hospital employees to describe their understanding of health equity as a concept, and perceptions of equity initiatives implemented in their hospital.…”