POSTER PRESENTATIONS of birth, fibrosis stage, mortality, anti-viral treatment status, treatment outcome, and lost to follow-up status. Two time-points have been considered for data analysis: firstly, the year of the first visit at our center and secondly, the most recent time-point the subject has been seen in our center. Results: A total of 1272 anti-HCV positive patients were identified and included in the data analysis. Median age at the first visit was 51.0 years (IQR 44–63). A total of 1129 patients (89%) had positive HCV RNA in plasma at baseline, 136 were HCV RNA negative, 35% of them had been treated before the first visit at the center and 27% had spontaneously cleared the virus. HCV genotype distribution in the study population was: 45% genotype 1, 15% genotype 2, 22% genotype 3, 8% genotype 4, and less than 1% genotypes 5 and 6 or mixed genotypes. 446 patients (35%) had significant fibrosis at baseline, assessed by either liver biopsy (>stage F2), clinical signs of portal hypertension or liver transient elastography above 10 kPa. A total of 816 patients (72% of the patients with positive HCV RNA at baseline) had access to HCV treatment (Figure 1). Of them, 383 patients were treated by ( peg)interferon and ribavirin, 633 were treated by DAA, of whom 197 received DAA as re-treatment after failure of ( peg) interferon-based treatment. A total of 713 patients (87%) that had access to treatment were cured (data on treatment outcome were missing in 35 patients). Conclusion: At least 29% (Figure 1) of the estimated HCV population in Ticino achieved sustained virological response (SVR) in the last 10 years, of whom 71% had been cured since the DAA therapies had been available. In Kantonsspital St. Gallen, characterized by a centralized model, the achievement of SVR in a similar period of time (2004– 2016) was 13%. If we compare the two models, the hub-and-spoke model used by our center, has allowed the treatment and healing of more than twice as many individuals as the centralized model. SAT285 A nurse led hepatitis C model of care in primary care and community services in Melbourne, Australia Brendan Harney1,2, Bradley Whitton1, Amanda Wade2,3, Rebecca Brereton4, Sarah Nolan5, Alexander Thompson6,7, Stuart Roberts8,9, Margaret Hellard1,2, Joseph Doyle1,2. 1Alfred Health & Monash University, Department of Infectious Diseases; 2Burnet Institute, Disease Elimination Program; 3Barwon Health, Department of Infectious Diseases; 4Alfred Health, St Kilda Road Clinic; 5Launch Housing; 6St Vincent’s Hospital Melbourne, Department of Gastroenterology; 7Melbourne University, Department of Medicine; 8 Alfred Health, Department of Gastroenterology; 9Monash University, Department of Medicine Email: brendan.harney@burnet.edu.au Background and Aims: Hepatitis C virus (HCV) testing and treatment at primary care and community based services will be a critical component of HCV elimination. We conducted an analysis of a nurseled service at nine sites to evaluate progression through the HCV care cascade from January 2017-September 2019. Method: People accessing services from nine sites including seven primary care services, a homeless service and a mental health service were either referred to nurses or engaged by nurses directly during regular visits. Nurses provided HCV education, testing and follow-up services. Those who tested HCV RNA positive were contacted by the nurse to discuss treatment and prescription was provided by an affiliated doctor or nurse practitioner. People with suspected cirrhosis based on transient elastography were referred to gastroenterology specialists. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. Results: A total of 688 people were referred to and/or engaged by the nurses; 564 had a HCV test of whom 420 (74%) were HCV RNA positive. Treatment was commenced by 324 (77%) with 207 (64%) prescribed by a general practitioner or a nurse practitioner. SVR testing was due for 288 by end September 2019, 174 (60%) were known to have had a SVR test, 169 (97%) were cured. Of those not cured, two were suspected reinfection, two were non-adherence and one was a relapse. Adjusted for age, gender and Aboriginal or Torres Strait Islander status, there was no significant difference in treatment commencement among people who reported injecting drug use in the last six months (aOR 0.58, 95%CI 0.26–1.31) compared to those who did not. Compared to people seen in primary care services, treatment uptake was significantly lower among those engaged through the homeless service (aOR 0.21, 95%CI 0.08–0.51). There were no significant differences in SVR testing among those who started treatment based on injecting in the last six months (aOR 1.75, 95%CI 0.83–3.72) nor engagement through the homeless service (aOR 1.96, 95%CI 0.45–8.56). Conclusion: A nurse-led model of care can lead to high levels of HCV treatment and cure among people attending primary care and community services. While specialist referral pathways are required for people with cirrhosis, restricting all HCV treatment to specialists is unjustified, as is restriction based on active injecting drug use. More tailored models of care are required for people attending homeless services. SAT286 Barriers to hepatitis C virus elimination in Germany: why aren’t diagnosed patients initiating therapy? Peter Buggisch1, Hans Heiken2, Stefan Mauss3, Bernd Weber4, Maria-Christina Jung5, Herbert Görne6, Renate Heyne7, Holger Hinrichsen8, Dennis Hidde9, Bettina König9, Ana Gabriela Pires dos Santos10, Claus Niederau11, Heiner Wedemeyer12, Thomas Berg13. 1Ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany; 2Private Practice, Hanover, Germany; 3Center for HIV and Hepatogastroenterology, Düsseldorf, Germany; 4Praxiszentrum Friedrichsplatz/Competence Center Addiction, Kassel, Germany; 5Liver Centre, Munich, Germany; 6 MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany; 7 Leberzentrum am Checkpoint, Berlin, Germany; 8Centre for Gastroenterology and Hepatology, Kiel, Germany; 9AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany; 10AbbVie Inc., North Chicago, IL, United States; 11Katholisches Klinikum Oberhausen, St. Josef-Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen, Germany; 12Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; 13Clinic and Polyclinic of Gastroenterology, Hepatology, Infectiology, and Pneumology, University Hospital Leipzig, Leipzig, Germany Email: buggisch@ifi-medizin.de Background and Aims: Despite the availability of effective and welltolerated direct-acting antivirals, many patients with chronic hepatitis C virus (HCV) infection delay or never initiate treatment. This observational study compared characteristics of patients who did and did not initiate HCV treatment and identified the reasons for this according to physicians. There were no budget constraints, as reimbursement is not a barrier to treatment in Germany. Journal of Hepatology 2020 vol. 73 | S653–S915 S795 POSTER PRESENTATIONS Figure: (abstract: SAT286) Method: The CURRENT-C study was an epidemiologic, non-interventional, case-control study that identified patients with chronic HCV infection in 43 sites in Germany (1 September 2017–30 June 2018). Baseline characteristics of patients who did or did not initiate treatment were evaluated. Reasons why physicians and/or patients decided against initiating or for delaying HCV treatment were collected. Results: Of 793 patients, 573 (72%) initiated treatment and 220 (28%) did not. Of those not initiating treatment, 88 (40%) delayed treatment and 132 (60%) had no therapy planned. In patients who did vs did not initiate treatment, 102 (18%) vs 76 (35%) were >60 years of age, 86 (15%) vs 32 (15%) were cirrhotic, 70 (12%) vs 40 (18%) were heavy alcohol users (>40 g/day [men]/>30 g/day [women]), 45 (8%) vs 48 (22%) had a history of injecting drug use, and 166 (29%) vs 93 (42%) were on opioid substitution therapy (OST), respectively. The most frequently reported reason for not initiating treatment was patient wish (93, 42%), particularly due to fear of treatment (38, 17%) or adverse events (29, 13%). Additional frequently observed reasons for not initiating treatment included perceived or expected lack of compliance, high patient age, comorbidities, drug/alcohol abuse, and OST (Figure). Conclusion: In this real-world population, 28% of documented patients with chronic HCV infection did not initiate treatment. Reasons to not initiate treatment other than patient wish included high age, drug abuse, and heavy alcohol abuse. Educating hesitant patients on the importance of treatment and overcoming historic barriers to initiating treatment, such as drug and alcohol use, is needed to achieve HCV elimination. SAT288 Description of HBV-infected persons presenting late to specialist care in 10 Spanish centres: A retrospective registry review Maria Buti1,2, Camila Picchio3, Sabela Lens2,4,5, Manuel Romero Gomez6, Raul J. Andrade2,7, Juan Ignacio Arenas Ruiz-Tapiador8, Joaquin Cabezas9, Javier Crespo9, José Luis Calleja Panero10, Manuel Hernández Guerra11, Miguel Angel Simón12,13, Jeffrey Lazarus3. 1Liver Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain; 2CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain; 3 Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; 4Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; 5IDIBAPS, University of Barcelona, Barcelona; 6Unidad de Gestión Clinico Aparato Digestivo, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; 7Unidad de Gestión Clínica de Enfermedade Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; 8Hospital S796 Universitario Donostia, San Sebastian, Spain; 9Gastroenterology and Hepatology Department. University Hospital Marques de Valdecilla. Research Institute Valdecilla-IDIVAL, Santander, Spain; 10Hospital Puerta del Hierro de Majadahonda, Madrid, Spain; 11Department of Gastroenterology, University Hospital of the Canary Islands, Tenerife, Spain; 12Department of Digestive Diseases, Hospital Clínico de Zaragoza, Zaragoza, Spain; 13Instituto de Investigación Sanitario Aragón (IIS Aragón), Zaragoza, Spain Email: camila.picchio@isglobal.org Background and Aims: There are an estimated 248 million people living with chronic hepatitis B in the world. Since 2008, there has been a consistent increasing trend in reported chronic HBV cases and continued importation of cases from high endemic countries to many EU countries. Despite Spain having screening and vaccination policies in place and unrestricted access to therapy, people present late to specialist care. We describe the characterists and country of origin of HBV-infected patients in Spain. Method: We conducted a retrospective cohort study through clinical history revision of patients seeking first time care with a liver specialist in ten tertiary Spanish hospitals between January 2018 and June 2019. Late presentation includes advanced liver disease (ALD) defined by significant fibrosis (≥F3 assessed by either APRIscore >1.5, FIB-4 >3.2, transient elastography (FibroScan) >9.5 kPa or biopsy ≥METAVIR stage F3) with no previous antiviral treatment. Prevalence of ALD at first consultation, country of origin, and risk factors were analyzed. Results: 398 patients were identified of which 59.8% were male and 54.5% were non-Spanish born. The average age was 46 and the average time from diagnosis to arriving in specialist care was 5.1 years. Patients whose country of origin was Africa made up 19.3% of all HBV cases with 28.5% (22/77) from Senegal followed by Guinea (15; 19.5%) and Ghana (7; 9.1%) (See Fig 1).11% of HBV cases were in Chinese-born individuals (n = 44) and four presented late to care. Non-Spanish born were significantly younger than Spanish born (38 vs 57 years; p < 0.0001) and Senegalese and Chinese migrants had a similar average age (34 and 38 years, respectively). Late presentation was detected in 11.6% (n = 46) of all cases and men were more likely than women to present late (6.9% vs 14.7%; p = 0.006). Those who presented late were older than those who did not (57 vs 46 years; p < 0.0001) and Spanish-born were more likely to present late to care compared to foreign-born individuals (17% vs 7%; p < 0.0001). Conclusion: Late presentation to HBV care is an issue in Spain. Targeted screening programs for high-risk Spanish populations and migrants arriving from high-endemic countries like Senegal and China need to be implemented. More than half of all reported HBV cases were in non-Spanish born persons. If Spain is to meet WHO targets to eliminate viral hepatitis as a major public health threat, efforts need to be made to identify HBV patients sooner. Journal of Hepatology 2020 vol. 73 | S653–S915