Clinic- and System-Level Factors Drive Racial Disparities in COVID-19 Antiviral Prescribing, Study Finds

Rebecca Bromley-Dulfano, MS

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A large cross-sectional study published in JAMA Network Open identified significant racial and ethnic disparities in outpatient COVID-19 antiviral treatment and attributed roughly half of the gap to differences in how and where people received care.1

The study analyzed electronic health records from 201 964 patients who tested positive for COVID-19 between January 1, 2022, and January 31, 2024, across a large academic health system in New England. Researchers found that Black and Latino participants were significantly less likely than White participants to receive outpatient antiviral prescriptions—by 10.8 and 9.8 percentage points, respectively—within 7 days of a positive test, reported Rebecca Bromley-Dulfano, MS, and Michael Barnett, MD, of Harvard T.H. Chan School of Public Health in Boston, Massachusetts.1

After controlling for patient-level clinical and public health factors, disparities remained. However, when encounter-level care factors—including test type, virtual care use, and site of care—were included, the prescription gap was largely explained. Among Black individuals, 53% of the difference was attributable to encounter-level characteristics; for Latino patients, it was 39%.1

Virtual care use and diagnostic test type were particularly influential. Compared with White participants, Black and Latino participants were less likely to be diagnosed using home or in-clinic antigen tests and less likely to receive care through telehealth. These disparities in care pathways translated into lower prescription rates for oral antivirals, despite comparable clinical eligibility.1

The study also found wide variability among clinic sites. Practices serving the highest percentage of Black and Latino patients were 8.2 percentage points less likely to prescribe antiviral medications than clinics with predominantly White patients. These practices were also less likely to use antigen tests or telehealth services, both of which were associated with higher prescription rates overall.1

Researchers suggest that improving access to rapid tests and virtual care—particularly at clinics serving historically marginalized populations—could reduce disparities in treatment. They caution, however, that structural determinants beyond the clinic level also play a role and must be addressed through broader policy efforts.1

"This study also offers a general approach for health care systems to better understand the factors underlying their local health disparities and create more targeted, community-specific interventions to address them in outpatient COVID-19 treatment or other areas of care," investigators wrote.1

In an accompanying editorial, Dovie Watson, MD, of the University of Pennsylvania in Philadelphia, and colleagues noted that these findings "showcase the importance of creating programs that address structural barriers to COVID-19-related care."2

"Regrettably, rather than working collectively to safeguard these programs and ensure their sustainability, multiple actors across governmental, social, economic, and health sectors have abdicated their duties to preserve such programs and ensure that resources for health and well-being are distributed more equitably," they wrote. "Unless policies and programs are enacted to ensure resources are equitably distributed across all populations, racial health inequities will persist and potentially widen over time."2

References:

1. Bromley-Dulfano R, Barnett ML. Racial inequities and access to COVID-19 treatment. JAMA Netw Open. Published online July 1, 2025. doi:10.1001/jamanetworkopen.2025.18459

2. Watson DL, Richmond J, Desai AN. Racial inequity and structural barriers to COVID-19 services. JAMA Netw Open. Published online July 1, 2025. doi:10.1001/jamanetworkopen.2025