Inequities in COVID-19 antiviral dispensation in Victoria, Australia: A retrospective cohort study using linked data.

Oral antiviral therapies are recommended for treatment of COVID-19 in people vulnerable to severe outcomes. This study examined COVID-19 antiviral dispensation and incidence of severe outcomes among eligible Victorians by socioeconomic status and cultural and linguistic diversity. A retrospective analysis was conducted using linked population data. Dispensation of COVID-19 antiviral treatment (molnupiravir or nirmatrelvir/ritonavir) is described, stratified by socioeconomic and culturally and linguistically diverse (CALD) status between 1 January and 30 June 2023 in Victorian residents aged ≥70 years. Rates of severe COVID-19 outcomes (hospitalisation or death) were also calculated from 1 November 2022 to 30 April 2023. Victorians living in areas of increasing socioeconomic disadvantage had steadily reduced COVID-19 antiviral dispensation in both CALD and non-CALD groups, with lower rates in CALD groups across all socioeconomic levels. The rate of severe COVID-19 outcomes showed the opposite trend. This analysis suggests that treatment access and outcomes are inequitable in Victorians eligible for COVID-19 antivirals. Increasing equity is a public health imperative.