P170 Emergency department screening and linkage to care for undiagnosed hepatitis C infection: an effective initiative to reach elimination targets

<h3>Background and Aims</h3> NHS England set a target to eliminate Hepatitis C (HCV) by 2025. As part of elimination efforts, selected emergency departments (ED) have implemented opt-out bloodborne virus (BBV) testing including HCV since April 2022. We describe how BBV testing in three Southeast London NHS Trusts has helped identify hard-to-reach patients, initiate them on treatment and achieve sustained virologic response (SVR). <h3>Method</h3> Patients seen in EDs in Southeast London with reactive HCV antibody results and positive reflex-tested HCV RNA or HCV core antigen between November 2022 to June 2024 were identified. Telephone contact was attempted with all patients and those accepting were offered follow-up and direct-acting antiviral (DAA) treatment. The clinical data and treatment outcomes were collected. <h3>Results</h3> In the 20-month period, 226,517 hepatitis C antibody tests were performed, and 303 patients had a positive diagnosis of HCV. 169 (55.8%) were new diagnoses. The median age was 53 years (IQR 43–64) and 207 were male (68.3%). 28 patients (9.2%) were clinically cirrhotic on presentation, 2 patients subsequently died of decompensated liver disease. 4 patients presented with hepatocellular carcinoma (HCC); all have subsequently died. In addition, 38 patients have also died from non-liver related causes. Of the 303 patients identified, 164 patients (54.1%) have been initiated on treatment with 107 patients having confirmed SVR. A further 39 patients have completed treatment awaiting SVR confirmation. 16 patients with confirmed SVR were diagnosed in ED but subsequently completed treatment in other non-hospital settings. 52 patients (17.2%) had no fixed abode or were in temporary accommodation, of whom 19 patients achieved SVR following an ED diagnosis. <h3>Conclusion</h3> ED screening effectively identifies new diagnoses of HCV infection; indeed 55.8% of HCV diagnoses here were in patients who had not been tested before. Many of these individuals did not have standard risk factors for infection and would not have been covered by other screening programmes. Of those linked into treatment, a high SVR rate is seen. A significant proportion of those diagnosed in ED were individuals without permanent residence but more than a third of these were still successfully linked into treatment and SVR. Barriers remain to linkage after an ED diagnosis; 45% of patients here were not linked and efforts are ongoing to engage with these patients and understand the barriers. Nonetheless, as we work towards elimination, ED testing has been a successful and powerful initiative to diagnose and cure patients with HCV.