P128 Defining the data requirement to achieve hepatitis C elimination in the United Kingdom: the somerset liver improvement project

<h3>Introduction</h3> Despite treatment initiatives to meet the WHO target of eliminating hepatitis C virus (HCV) by 2030, many patients with HCV in the UK are not yet linked to specialist services or treated. Using a novel case-finding database in Somerset (609,474 individuals), we aimed to identify unknown and untreated HCV patients and determine the impact of deprivation on this patient population by refining the methodology to identify HCV patients for treatment. <h3>Method</h3> The database was configured to identify two groups of patients: – those with persistently abnormal liver function tests (LFTs) and no HCV test; and those with positive HCV antibody (Ab) between 2004–2023 (age 18–70). Clinical and ‘high-cost drug’ records were reviewed to determine treatment status, spontaneous HCV clearance, and/or sustained virological response (SVR) post-treatment. Postcodes used to determine patients’ Index of Multiple Deprivation (IMD) comparing most deprived deciles (IMD 1–2) with the rest (IMD 3–10) in line with the NHS Core20Plus5 programme. The cohort requiring treatment was queried for overlap with the ‘lost positives’ (NHS England programme) from 2018. <h3>Results</h3> 14,525 had persistently abnormal LFTs (ALT&gt;40; 90 days). However, 67% of them had never had HCV Ab tests. 1001 patients had positive HCV Ab (current or prior), significantly weighted towards deprived areas (0.63% in IMD1–2; 0.21% in IMD3–10; p&lt;0.0001). The mortality of HCV Ab-positive patients was significantly higher in deprived areas (25.2% in IMD1–2, 18.6% in IMD3–10; P=0.045), with a median age of death at 49 years. Overall, 694 alive HCV Ab positive patients were identified. Of them, 442 were either HCV PCR negative or treated. 120 were identified as requiring treatment; 132 needed further investigation. Concerningly, 11% (75 patients) had never had an HCV PCR test, and a further 74 had failed to engage with our service (although neither of these groups was associated with IMD). Of the patients requiring treatment now, only 13% were seen in the local ‘Lost Positives’ cohort identified by the NHS England Programme (2018). <h3>Conclusion</h3> Our data suggests finding and treating majority of HCV cases requires a systematic approach to ensure all patients with abnormal LFTs have HCV Ab status checked; ensuring all HCV Ab positive patients have PCR status checked and confirmed where negative; data across multiple geographies (patients with missing results may have had them elsewhere), and regular data refresh with an iterative approach. Further work is underway to offer investigation and/or treatment to the relevant patients in Somerset. <h3>References</h3> World Health Organization . Global health sector strategies on viral hepatitis 2016–2021. 2016. UK Health Security Agency. Hepatitis C in the UK 2023 working to eliminate hepatitis C as a public health threat. 2023. NHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. 2022.