Custom actions work with VoiceOver, Switch Control and Full Keyboard Access. They also do for Voice Control. You can say "Show actions for <item name/number>", and an action sheet with all options, numbered, will be presented to the user.
For some use-cases, Voice Control users might not feel it is a big win. Navigation is not as big of an issue, and interacting with custom actions might be a bit trickier than with "exposed" buttons. But lots of times seems a fair compromise.
You may also find interesting...
Test manually. Familiarise yourself with different assistive technologies. I find it useful to start with VoiceOver but check out Voice Control, Full Keyboard Access, and others... Remove friction, configuring shortcuts can help. Merry Christmas!
Grouping elements when it makes sense can make a huge impact on easing navigation with some assistive technologies like VoiceOver, Switch Control, or Full Keyboard Access. It also helps on reducing redundancy.
Accessibility labels might not be the best input labels, used for example to find or interact with elements with Voice Control or Full Keyboard Access. In those cases, you can provide accessibility user input labels.
