P140 Characteristics of a prospective cohort undergoing assessment for hepatitis C treatment in London and time to treatment initiation

<h3></h3> The characteristics of individuals living with untreated hepatitis C in the UK have not been well-described and this limits the ability of clinical teams to address barriers to care. We aimed to characterise a cohort of people undergoing assessment for hepatitis C direct-acting antiviral (DAA) treatment and measure time to treatment initiation. We conducted a prospective cohort study including individuals attending a nurse-led assessment in clinics in North London (May-December 2022). Baseline questionnaires were self-completed on the day of assessment and follow-up (by linkage to a clinical patient management system) was for at least three months. Questionnaires collected data on socioeconomic status, drug and alcohol use and mental health, beliefs about DAA treatment and experiences of stigma. A descriptive analysis was performed. Clinic non-attendance was 48% (54/113) but study acceptance was high at 86% (43 of 50 individuals approached to participate). Of the 39 study participants who returned a questionnaire, 67% were male, mean (range) age was 52 (27–86) years, 56% were UK-born, 23% unstably housed, 56% did not always have money for basic needs and 59% of these were severely food insecure (by the Household Food Insecurity Access Scale). Over half (56%) had a mental health diagnosis, 43% had PHQ9 scores consistent with depression and 38% had GAD7 scores in keeping with anxiety. 16% had an AUDIT score suggestive of higher risk drinking. Almost a third (31%) were diagnosed via ED opt-out testing and 21% had previously missed an appointment or declined hepatitis C treatment. 41% reported perceived stigma relating to hepatitis C. Over 90% believed that DAA treatment would be of benefit but 66% thought that it would have side effects and 54% that treatment would require a liver biopsy. The majority (87%) started DAA treatment during follow-up and the median time from assessment to treatment start was 47.5 days (IQR 41, range 13–184). Almost all (97%) of these completed treatment and (of those who had at least three months of follow-up available after completion), 55% (11/20) had confirmation of viral cure. This small cohort demonstrates that factors previously shown to be associated with disengagement from hepatitis C care are highly prevalent in those attending assessment for treatment. Subsequent treatment initiation and completion rates were high, highlighting the ascertainment bias that complicates prospective studies of patient disengagement. The high non-attendance rate emphasises that greater efforts are needed to enable engagement with care amongst people experiencing barriers to access.