P130 Experience of active hepatitis C prevalence in liverpool city centre as determined by ED reflexive testing; reflections on how we got here

<h3></h3> In 2019, a multi-centred UK study procured residual blood samples from several ED sites, including Liverpool, finding high levels of active HCV, often in patients unaware of their HCV status. ED reflexive testing for blood borne viruses (BBV) commenced in Liverpool in April 2023. RNA testing was reflexively done for Ab positive samples with these results forwarded onto the clinical team for data collection and treatment initiation. Six months after introduction, we reviewed the findings and patient outcomes. We found a significant improvement in the prevalence of active HCV despite the COVID-19 pandemic. We conducted semi-structured interviews (SSI) with key members of the operational delivery network (ODN) to determine how we have achieved this local success. Between April and October 2023, 52 individual patients were identified as HCV RNA positive through our ED reflexive testing. Of these, 61.5% were new to the ODN and 13.5% were re-infections in patients with previous recorded sustained virologic response (SVR). This gave a prevalence in the ED population of 0.25%.Of patients new to the ODN, 90.6% received, or were ineligible for, treatment. Of the re-infections, 85.7% accepted treatment following reflexive result but of those who had been previous non-engagers with the ODN, only 53.9% accepted treatment following the ED result. At 8 weeks from the last positive ED result in this period, 71.2% of patients had commenced treatment for HCV. In 2019 at the same hospital, prevalence of RNA positivity in ED residual blood samples was 2.73%.In autumn 2023, NHSE reported a steady ED HCV RNA positive prevalence of 0.60%. A variety of novel techniques have been used by this ODN and within the hospital over the last 4 years to maximize patient engagement, including; a ‘tracker’ algorithm for patients having acute contact with the hospital, re-engagement via invitation to bloods programs in multiple years, GP case-finding algorithms and the Hep C nurses and Peers establishing minimal contact safe treatment systems. ED Reflexive testing has been effective for case finding locally. It has confirmed recent regional low yield of RNA positive cases is likely secondary to a genuine reduction in the number of active cases in the community and suggests that non-standard methods of engagement and case finding have been vital in this reduction. Future resources need to target the chronically hard to engage and those at risk of re-infection as these groups pose the greatest risk as we continue to strive for elimination.