{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:13:16Z","timestamp":1780089196816,"version":"3.54.0"},"posted":{"date-parts":[[2026,5,26]]},"group-title":"Health Informatics","reference-count":20,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health","award":["75N92022D00010"],"award-info":[{"award-number":["75N92022D00010"]}]},{"name":"National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health","award":["T32HL171799"],"award-info":[{"award-number":["T32HL171799"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Home Test-to-Treat (HTTT) programs deliver timely antiviral treatment for acute respiratory infections, including COVID-19 and influenza, through at-home testing and telehealth. Because access is often measured by visit occurrence, variation in how and when care is delivered may be overlooked. We hypothesized that telehealth access follows distinct process-based patterns.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed de-identified encounters from the national HTTT program (September 2023\u2013July 2024); 6,213 of 8,160 eligible individuals remained after exclusions for missing data. Phenotypes were derived by k-means clustering of standardized variables capturing encounter timing, modality preference, process duration, and sociodemographic and digital access attributes. Ten-day surveys assessed symptom duration and healthcare utilization.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Three phenotypes emerged: Delayed\/Disrupted Access (n = 1,537; 24.7%), Digitally Engaged but Socioeconomically Vulnerable (n = 1,460; 23.5%), and Mainstream Access and Efficient Utilization (n = 3,216; 51.8%). Mean process duration differed (15.93 [SD 3.84] vs 3.69 [3.31] vs 2.87 [2.41] hours; p &lt; 0.001). Synchronous preference was lowest in the Digitally Engaged group (22.9%); antiviral prescribing was high (88.6%\u201391.9%). Among 10-day respondents (n = 1,023), symptom duration did not differ. Emergency department visits were most frequent in the Digitally Engaged group (2.3% vs 0.0% and 0.5%; p = 0.02) and urgent care in the Delayed\/Disrupted group (5.8% vs 4.1% vs 2.0%; p = 0.02).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Telehealth use in a national HTTT program formed distinct phenotypes defined by timing, modality, and care-process efficiency. Evaluating equity requires attention to how and when care is delivered, not simply whether it occurred.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.24.26353984","type":"posted-content","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T02:15:12Z","timestamp":1779848112000},"source":"Crossref","is-referenced-by-count":0,"title":["Variation in Telehealth Use in a National Home Test-to-Treat Program for Acute Respiratory Infections"],"prefix":"10.64898","author":[{"given":"Wojciech R.","family":"Losos","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA"},{"name":"Program in Digital Medicine, UMass Memorial Medical Center, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA"},{"name":"Program in Digital Medicine, UMass Memorial Medical Center, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA"},{"name":"Program in Digital Medicine, UMass Memorial Medical Center, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-3657","authenticated-orcid":false,"given":"Apurv","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA"},{"name":"Program in Digital Medicine, UMass Memorial Medical Center, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben S.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026052913550810000_2026.05.24.26353984v1.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6943a3"},{"key":"2026052913550810000_2026.05.24.26353984v1.2","unstructured":"National Institutes of Health. NIH launches Home Test to Treat, a pilot COVID-19 telehealth program. Published March 7, 2023. Accessed February 15, 2026. https:\/\/www.nih.gov\/news-events\/news-releases\/nih-launches-home-test-treat-pilot-covid-19-telehealth-program"},{"key":"2026052913550810000_2026.05.24.26353984v1.3","unstructured":"National Institutes of Health. Home Test to Treat program extends nationwide. Published December 6, 2023. Accessed February 15, 2026. https:\/\/www.nih.gov\/news-events\/news-releases\/home-test-treat-program-extends-nationwide"},{"key":"2026052913550810000_2026.05.24.26353984v1.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2118542"},{"key":"2026052913550810000_2026.05.24.26353984v1.5","unstructured":"World Health Organization. Global Strategy on Digital Health 2020\u20132025. World Health Organization; 2021. https:\/\/www.who.int\/publications\/i\/item\/9789240020924"},{"key":"2026052913550810000_2026.05.24.26353984v1.6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.22302"},{"key":"2026052913550810000_2026.05.24.26353984v1.7","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.02022"},{"key":"2026052913550810000_2026.05.24.26353984v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01152-2"},{"key":"2026052913550810000_2026.05.24.26353984v1.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016242"},{"key":"2026052913550810000_2026.05.24.26353984v1.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.7858"},{"key":"2026052913550810000_2026.05.24.26353984v1.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0282"},{"key":"2026052913550810000_2026.05.24.26353984v1.12","doi-asserted-by":"publisher","DOI":"10.1068\/a4360"},{"key":"2026052913550810000_2026.05.24.26353984v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2016.10.023"},{"key":"2026052913550810000_2026.05.24.26353984v1.14","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07827-4"},{"key":"2026052913550810000_2026.05.24.26353984v1.15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0001193"},{"key":"2026052913550810000_2026.05.24.26353984v1.16","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.20.0123"},{"key":"2026052913550810000_2026.05.24.26353984v1.17","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.2666"},{"key":"2026052913550810000_2026.05.24.26353984v1.18","doi-asserted-by":"publisher","DOI":"10.2196\/19361"},{"key":"2026052913550810000_2026.05.24.26353984v1.19","doi-asserted-by":"publisher","DOI":"10.1089\/tmr.2023.0052"},{"key":"2026052913550810000_2026.05.24.26353984v1.20","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09445-0"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.05.24.26353984","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:55:15Z","timestamp":1780088115000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.05.24.26353984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":20,"URL":"https:\/\/doi.org\/10.64898\/2026.05.24.26353984","relation":{},"subject":[],"published":{"date-parts":[[2026,5,26]]},"subtype":"preprint"}}