P90 Non-engagement in HBV care, who and why: findings from the first 18 months of opt out BBV testing

<h3>Introduction</h3> HBV is a silent disease, often diagnosed through targeted screening. Blood borne virus (BBV) screening has been introduced in Emergency Departments (ED), commencing at our site in November 2022. We aimed to characterise patients who were identified as being Lost to Follow up (LTFU) from HBV care and also patients with HBV who could not be linked to care (Unlinked). <h3>Methods</h3> LTFU is defined as known diagnosis of HBV, not seen for &gt;12 months. Unlinked patients were identified as hepatitis B surface antigen positive (HBV Sag) but did not attend for appointments. We extracted the demographics of both groups from our ED screening database. Using the home postcode, Index of multiple deprivation (deciles) was calculated (1 most deprived, 10 least deprived). We also conducted a look back exercise through the 40 unlinked patient records to ascertain common themes. <h3>Results</h3> During the first 18 months of ED opt out testing, 837 patients tested positive for viral hepatitis. 715 (85.42%) of those patients tested HBsAg positive. Of these, 173 (24.20%) were new diagnoses, 407 (56.92%) known HBV (351 in care &amp; 56 LTFU), 40 (5.59%) Unlinked to care. The characteristics of the unlinked patients and LTFU were similar. Of the LTFU group, 34 (61%) were male, median age 46 yrs, 38 (68%) black ethnicity, 5 (8.9%) white ethnicity, 8 (14%) Asian. 36 (64%) lived in postcodes with deprivation index 1–3. Of the patients unlinked to care, 31 (61%) were male, 20 (50%) were black ethnicity, 1 (2.5%) white, 3 Asian (7.5%). 21 (52%) lived in areas with deprivation index 1–3. Pie chart 1: the reasons patients were not linked to care: <h3>Discussion</h3> In the unlinked and LTFU groups, there were more males than females, with similar median ages. Both groups had a diverse range of ethnicities. The proportion living in deprived areas was notably high in both groups. The reasons that patients were unlinked is because they were uncontactable, had vulnerabilities (addiction, homelessness, mental health conditions) or were in denial about their HBV. Education, advocacy and peer support are key to improving engagement with HBV care in these populations. These findings suggest that reduced engagement in HBV care, whether falling out of care or failure to link to care after a new diagnoses, is a health inequality. More work needs to be done with ethnically diverse and deprived communities to educate and empower them to engage with HBV services.