P172 Emergency department opt-out testing for hepatitis C: a different risk profile and increased case-finding

<h3></h3> Opt-out testing for blood-borne viruses (BBV) in emergency departments (ED) is being rolled out nationally, following a London-based pilot. This is partly funded by the NHS hepatitis C elimination program to accelerate progress towards the WHO hepatitis C elimination target of 2030. This study assesses patient characteristics and engagement in care compared to standard referral pathways across a large representative cohort. We undertook a multicentre retrospective study of HCV RNA+ patients across 7 EDs from North and South London. Recruitment was between April 2022 and April 2024 for a minimum of 12 months with a 6-month follow-up period. Patient and disease characteristics were compared with those referred by standard routes in same period (community drug services, prisons, primary and secondary care – ‘non-ED’). A total of 342616 HCV Ab tests were performed at the study sites representing 28% of all tests performed in the programme this period. 253 HCV RNA+ patients were identified after exclusion of 18 false-positives. 28 patients were not contactable by phone or post. Of the remaining 225, 19 were already under follow-up and 206 were not under care. Of these, 174 were new to service and 32 were lost to follow-up. 183/206 (88.8%) were successfully engaged for clinical assessment. Of those assessed, a similar proportion progressed to treatment (90.7% ED versus 90.9% non-ED, 2-sided Pearson Chi Sq test, NS) and achieved sustained virological response (SVR12) within the censor dates (72.1% ED versus 73.5% non-ED, 2-sided Pearson Chi Sq test, NS). In the ED cohort, 30.4%, 18% and 9.9% of patients had liver stiffness measurements greater than 8.9, 11.4 and 19.9 kPa respectively. 3 new cases of HCC were identified. The ED cohort was significantly older (mean age 56.8 vs 50.1, p &lt;0.001, 2-sided t-test) and the minority spoke English as a first language, whereas the inverse was true in the non-ED group (35.9% ED vs 69.5% in non-ED, 2-sided Pearson Chi Sq test, p&lt;0.001). A history of past/current injected drug use was significantly lower in the ED cohort (26.5% ED vs 52.1% non-ED, P&lt;0.001). HCV genotype distribution also differed significantly (genotype 1: 42% ED versus 69% non-ED, p &lt; 0.001). ED testing resulted in a 40% increase in HCV assessments in the study period. ED opt-out HCV testing enhances case-finding in a population with different demographics and transmission risks than standard pathways and, with high rates of assessment and treatment, contributes meaningfully to HCV elimination efforts.