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INTRODUCTION Safely increasing organ donation to meet need is a priority. Potential donors may be declined due to perceived blood borne virus (BBV) transmission risk. With hepatitis C (HCV) curative therapy, more potential donors may now be suitable. We sought to describe potential deceased donors with increased BBV transmission risk. METHODS We conducted a cohort study of all potential organ donors referred in New South Wales, Australia, 2010-2018. We compared baseline risk potential donors to potential donors with increased BBV transmission risk, due to history of HIV, HCV or hepatitis B and/or behavioural risk factors. RESULTS There were 624/5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298/5749 (5.2%) with HCV (including HBV co-infections) and 239/5749 (4.2%) with increased risk behaviours (no known BBV). Potential donors with HCV and those with increased risk behaviours were younger and had fewer comorbidities than baseline risk potential donors (p

PurposeBrazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.Design/methodology/approachAll non-Brazilian patients (n= 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n= 40) and non-heroin users (n= 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.FindingsMost participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.Originality/valueThis study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.

The primary aim of the current study was to test the effect of the presentation design of a test alert system on healthcare workers’ (HCWs’) decision-making regarding blood-borne virus (BBV) testing. The secondary aim was to determine HCWs’ acceptance of the system. An online survey used a within-subjects research design with four design factors as independent variables. The dependent variable was clinical decision. Ten realistic descriptions of hypothetical patients were presented to participants who were asked to decide whether to request BBV testing. The effect of a pre-set course of action to request BBV testing was significant when additional information (cost-effectiveness, date of last BBV test or risk assessment) was not presented, with a 16% increase from 30 to 46% accept decisions. When risk assessment information was presented without a pre-set course of action, the effects of cost-effectiveness (27% increase) and last test date (23% decrease) were significant. The main reason for declining to test was insufficient risk. HCWs’ acceptance of the test alert system was high and resistance was low. We make recommendations from the results for the design of a subsequent real-world trial of the test alert system.

Objective: Patients with a severe mental illness have higher rates of infection with blood-borne viruses (BBVs) but are less likely to access testing and treatment. Enhanced testing of this population is therefore warranted. Methods: In this single centre, prospective study, we sought to offer testing for BBVs to all patients who attended an appointment in the clozapine clinic (CC) over a six-month period. Those who consented were tested for HIV antigen/antibody, hepatitis C virus (HCV) antibody and hepatitis B virus surface antigen (HBsAg). Results: During the study period, 192 patients attended an appointment, of which 164 were offered testing. Of those, 134 (81.7%) accepted and 30 declined. Among patients who agreed to be tested, results were returned for 96 (71.6%). There were no positive results for HBsAg or HIV. Seven patients (7.2%) were positive for HCV antibody. Of those, three were newly identified exposures of which two were found to be chronically infected and were referred for treatment. Conclusion: A routine offer of BBV testing for people with severe mental illness in the outpatient setting is feasible and may detect treatable infections.

Innovative care pathways including case finding and linkage to care are crucial to achieve the World Health Organization targets for the elimination of viral hepatitis.(1) In England there were over 23.4 million attendances at Emergency departments (EDs) in 2016-17 representing a significant opportunity to engage for case finding.(2) EDs may be the only healthcare access point for some marginalised groups including recent migrants, homeless, or people who inject drugs. Seroprevalence studies have been used in the USA to guide public health interventions where large scale, integrated ED testing and linkage programs are increasingly common.(3) Since 2008 routine opt-out testing for HIV in UK ED settings has been recommended for those in high prevalence areas (>0.2%). This article is protected by copyright. All rights reserved.

Introduction: Hepatitis C (HCV) infection in England primarily affects people who inject drugs (PWID). We describe persons HCV tested, estimate incidence and establish the cascade of care (CoC) for people engaging with drug services.Methods: Persons testing for HCV in drug services in Sentinel Surveillance of Blood Borne Virus Testing (SSBBV) between 2008 and 2016 were linked with people attending drug services in the National Drug and Treatment Monitoring System (NDTMS). We describe risk characteristics, establish the CoC, and estimate HCV incidence in PWID diagnosed in drug services. Results: Of 46,721 persons tested for anti-HCV in SSBBV in drug services, 29,773 (63.7%) linked to NDTMS. Of these, 9100 (30.6%) were antiV positive and anti-HCV positivity was 45.0% in persons reporting urgent housing problems and 43.8% in persons reporting ever injecting. Among persons anti-HCV positive, half had ≥1 positive anti-HCV test. For persons’ first anti-HCV positive between 2008 and 2013 (n = 3123), 74.9% were HCV RNA tested, of whom 71.2% were RNA positive, and of these, 14.0% had evidence of interferon-based treatment, with 52.8% achieving cure. Among PWID, HCV incidence was 8.7 per 100 person-years (95% CI: 8.1–9.2). Conclusion: Through record linkage of surveillance datasets, we estimated the HCV CoC for people attending drug services, providing a benchmark from which to monitor the impact of strategies to scale-up prevention, testing, and curative treatment with direct acting antivirals. Our study highlights wasteful repeated testing and poor linkage to care for this high risk population which need to be addressed.

This study aims to determine whether previous exposure to a total prison smoking ban is associated with a reduction in daily smoking postrelease and to identify the factors associated with daily tobacco use. Demographics, incarceration history, and substance use data were collected from the 2016 National Prisoner Entrants' Blood Borne Virus Survey for 389 Australian prison entrants. Predictors of daily smoking among those exposed to a smoking ban were illicit drug use and Indigenous status. No significant association was found between current daily smoking and recent exposure to a prison smoking ban, suggesting that the majority of Australian prisoners exposed to a tobacco ban while incarcerated will return to smoking once released. Complementary and culturally specific interventions supporting abstinence postrelease should be considered.

Background ICU patients may require renal replacement therapy (RRT). Sharing RRT equipment carries a risk of BBV transmission, which mainly relates to Hepatitis B (HBV), Hepatitis C (HCV) and HIV. Since 2012, all Glasgow Royal Infirmary ICU patients undergo routine BBV screening, with RRT machines allocated for patients with specific BBV statuses. Routine BBV testing is beneficial to both the individual and society. This study aims to determine if routine BBV testing in the ICU contributes to the discovery of undiagnosed BBV infections. Methods This single-centre retrospective observational study examined prospectively collected clinical data from 1069 ICU admissions. Proportions were compared using a two-proportion z-test and a logistic regression model was carried out to determine if deprivation quintile was independently associated with the seroprevalence of BBVs. Results The BBV seroprevalence in the cohort studied: 0.45% (HBV), 11.7% (HCV), and 0.91% (HIV). The seroprevalence of HBV in the cohort studied was similar to that of Scotland (p = 0.11), but the seroprevalence of HCV (p Conclusion This study shows that routine BBV testing in the ICU is useful in discovering new BBV infections. This is the first observational study focusing on the value of routine BBV testing in an ICU setting to our knowledge.

Contemporary sociological work has emphasised that family is not static, but actively shaped by ideas of who and what makes family. Disclosure of an illness, including diagnosis of stigmatised infections such as HIV, hepatitis B virus and hepatitis C virus, can change the dynamics of family relationships. This paper draws on 61 qualitative semi-structured interviews conducted between 2017 and 2019 with people in Australia with one or more of these blood-borne viruses (BBVs) and their family members, to understand the experiences of serodiscordant (mixed viral status) families. Through a thematic analysis, we explore the family imaginaries that participants evoked when describing their disclosure practices in relation to (self-defined) family members, revealing how some participants disclosed in ways that enabled them to shape their family, to maintain boundaries between self and family or to protect family from distress. Participants' accounts of disclosure to family revealed imaginaries of family as a precious web of connections to be nurtured or protected, but also as sites of ambivalent belonging and complex history. We conclude that BBV disclosure practices within families reveal important ideas about families that are imagined in response to the threat of loss, change and stigma.

The risk of coronavirus disease 2019 (COVID‐19) for people living with HIV (PLWH) is poorly understood. The vast majority of reported cases of COVID‐19/HIV co‐infection consists of those with an established HIV diagnosis who are on anti‐retroviral therapy (ART). Better knowledge of the effects of COVID19 on HIV patients who are ART naïve is required. Two cases of previously undiagnosed HIV presenting to secondary care with respiratory symptoms are detailed in this series, with a view to extrapolate lessons on blood borne virus (BBV) screening in the COVID‐19 era. This article is protected by copyright. All rights reserved.

Blood-borne viruses (BBVs) are an established focus of drug research and harm reduction. While a focus on BBVs has been applied to people who inject image and performance enhancing drugs (IPEDs), research has demonstrated that there are significant differences between this group and people who inject other drugs. Furthermore, the literature on BBVs and IPED use has been misrepresented by the media and harm reduction programs, with significant consequences for how some people who inject IPEDs view academic research and health services. It seems time to ask, is our current approach to the issue of BBV among people who inject IPEDs the most appropriate, and are there ways that it could be improved to ensure that there are no unintended consequences? In this commentary I suggest ways research and harm reduction efforts could tackle the issue of BBV without exacerbating existing divides between people who inject IPEDs and the health and academic communities. These suggestions are based on the views of the enhanced bodybuilders with whom I am privileged to work.

Background: Patients in a high secure hospital are a high-risk population for exposure to blood-borne viruses (BBV) because of previous lifestyles. Objective: This service improvement study intends to improve patients care by the Infection Prevention and Control Team (IPCT) coordinating the BBV screening and vaccination programme within the hospital. Methods: A retrospective review of patients’ notes in 2007 and 2016 was used. Results: The results show an increase in screening offered and screening undertaken from 2007 to 2016. It also identifies an increase in hepatitis B vaccination programmes completed. Discussion: The expansion of the IPC and Physical Healthcare Team appear to be associated with the increase of screening and vaccination rates.

Background A significant proportion of international students at UK universities are from regions with medium to high hepatitis B prevalence rates. Understanding the perception of students regarding hepatitis B infection is crucial for the development of appropriate information and services for this population group. Methods Twenty semi-structured interviews were conducted with students from the University of Aberdeen. The following key areas were covered: knowledge, awareness, practices including testing, cultural and social aspects and general attitudes to health information and services. Interviews were transcribed verbatim and coded using a framework analysis approach. Results The participants acknowledged hepatitis B to be a serious disease yet did not consider themselves to be at risk. They felt able to go to their General Practitioner if concerned about hepatitis B but emphasised that there was no indication that this was required. There was a general lack of knowledge about the disease including confusion over other types of hepatitis. This was linked to the perceived lack of attention given to hepatitis B in, for example, sexual health education and disease awareness raising campaigns. The participants expressed a desire for information on hepatitis B to be relevant to the student population, easy to understand, socially acceptable and easily accessible on student portals and social media platforms. Conclusions Our study suggests that students in Aberdeen, North East Scotland lack knowledge and awareness of hepatitis B and do not perceive themselves as being at risk of hepatitis B infection. There is a need for more tailored hepatitis B messages to be incorporated into a range of contexts with clearer risk communication for the student population.

Background UK migrants born in intermediate to high prevalence areas for blood borne viruses (BBV) including hepatitis B, hepatitis C and HIV are at increased risk of these infections. National guidance from Public Health England (PHE) and National Institute for Health and Care Excellence (NICE) recommends primary care test this population to increase diagnoses and treatment. We aimed to investigate primary care professionals’ knowledge of entitlements, and perceptions of barriers, for migrants accessing healthcare, and their policies, and reported practices and influences on provision of BBV testing in migrants. Methods A pre-piloted questionnaire was distributed between October 2017 and January 2018 to primary care professionals attending the Royal College of General Practitioners and Best Practice in Primary Care conferences, via a link in PHE Vaccine Updates and through professional networks. Survey results were analysed to give descriptive statistics, and responses by respondent characteristics: profession, region, practice size, and frequency of seeing migrant patients. Responses were considered on a per question basis with response rates for each question presented with the results. Results Four hundred fourteen questionnaires were returned with responses varying by question, representing an estimated 5.7% of English GP practices overall. Only 14% of respondents’ practices systematically identified migrant patients for testing. Universal opt-out testing was offered to newly registering migrant patients by 18% of respondents for hepatitis B, 17% for hepatitis C and 21% for HIV. Knowledge of healthcare entitlements varied; fewer clinical staff knew that general practice consultations were free to all migrants (76%) than for urgent care (88%). Performance payment structure (76%) had the greatest reported influence on testing, followed by PHE and Clinical Commissioning Group recommendations (73% each). Language and culture were perceived to be the biggest barriers to accessing care. Conclusions BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed. Knowledge of migrants’ entitlements to healthcare varies and could affect access to care. Interventions to improve professional awareness and identification of migrant patients requiring BBV testing are needed to reduce the undiagnosed and untreated burden of BBVs in this vulnerable population.

Background Hepatitis C virus infection (HCV) is common in prisons in the UK with estimates suggesting a prevalence of approximately 7%. One of the goals of NHS England is to eliminate HCV from the country by 2025. In order to facilitate elimination of HCV from prisons, funding was available to conduct high intensity test and treat (HITT) initiatives in prisons with the aim of testing >95% of residents for HCV and treating >90% of those with active HCV, which is considered ‘elimination’. We describe the outcomes of a HITT conducted in Low Newton prison, in County Durham, which houses 307 female residents. Methods A Blood borne virus (BBV) testing weekend was conducted in January 2020 following detailed planning from a multidisciplinary team. The testing weekend was well publicised among residents. All residents were offered BBV testing using fingerpick dry blood spot testing for HCV antibody/RNA, HIV, HBsAg and Syphilis. A small incentive was given to all those tested. All HCV RNA positive were offered a clinic review 10 days after testing to commence treatment with a pangenotypic antiviral. Results Of the 307 residents in the prison at the time of the event, 305 (99%) accepted BBV testing. A total of 98 (32%) were HCV antibody positive, of these 23 were HCV RNA detected (23% of HCV Ab pos and 8% of all tested) in keeping with active HCV. One resident was HIV positive (known) and 4 had positive syphilis serology. None were HBsAg positive. Of the 23 HCV RNA positive residents, 3 were already on antiviral treatment, 17 commenced antivirals and 3 were released before treatment could be initiated (contact planned in the community). One patient was suspected of having cirrhosis. Of the 75 HCV antibody positive but RNA negative residents 40 (53%) were known to have received antiviral treatment already and achieved sustained virological response and 10 (13%) were currently on treatment. Feedback from residents and staff on the way the HITT was conducted was good. A point of care HCV RNA testing machine is now being used to identify HCV infection among new residents to try and maintain ‘elimination’. Conclusions A high intensity test and treat weekend coupled with quick access to antiviral treatment for HCV is a highly effective way to ‘eliminate’ HCV within a prison. However, these sessions require meticulous planning in order to be successful. Acknowledgment All the staff and residents of HMP Low Newton and the Hepatitis C Trust.

IntroductionSolid organ transplant recipients are at risk of infections, which may be either derived through transplantation or acquired later. Blood-borne viruses (BBV) are a particular concern for donor-derived transmissions. There is an increasing emphasis on biovigilance – monitoring the safety of donated organs. However, systematic surveillance to distinguish donor-transmitted infection from de novo post-transplant infection is challenging. Additional information can be obtained through linkage of administrative health data. Objectives and ApproachWe aimed to identify donor-transmitted and de novo BBV infections among organ transplant recipients. We conducted a cohort study of all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. Donor and recipient BBV infections were identified by linking transplant registries with administrative health data. Proven/probable donor-transmissions were identified among new recipient infections within 12 months of transplant, classified according to an international algorithm. All other new BBV infections were classified as de novo infections. ResultsAmong 2,120 organ donors, 73 had a BBV infection (11/73 active, 62/73 past). Donors with BBV donated to 176 recipients, of whom 24/176 had the same BBV as their donor, and 152/176 did not; these 152 recipients were at risk of donor-transmission. Among those at risk, there were 3/152 proven/probable BBV transmissions (1 hepatitis C, 2 hepatitis B [HBV]) and 149/152 recipients with non-transmissions. All donor-transmissions were previously recognised by donation services, and were from donors with known BBV. There were no deaths from transmissions. There were 70 recipients with de novo BBV; 2/70 died from new HBV. Conclusion / ImplicationsThis work confirms the safety of Australian organ donation, with no unrecognised BBV transmissions and many non-transmissions from donors with BBV. This may support increasing targeted donation from donors with BBV. However, de novo BBV infections were substantial and preventable. Data-linkage may be a useful adjunct to current biovigilance systems.

Background: Hepatitis C virus (HCV) is a disease of significant global impact, every family in Egypt is touched by hepatitis C virus infection, this blood borne virus which is highly infectious. The aim of study: to assess the hepatitis C virus patients' adherence to infection control precautions at homes Materials and methods: A cross sectional design was utilized in this study; the study was conducted at the outpatient clinics in El-Salam International Hospital affiliated to Ministry of Health and Population at Mansoura City. The sampling method used was convenient sample included 430 hepatitis C virus patients who attended to outpatient clinic in El-Salam International Hospital affiliated to Ministry of Health and Population at Mansoura City to receive hepatitis C virus treatment. Tools: Three structured interviewing tools were used to assess socio-demographic and economic data, adherence of patients to infection control precautions at homes and factors that hinder the patients from adherence to infection control precautions at homes. The data were analyzed using SPSS (Stand for statistical product and service solutions) version 16.Results: revealed that there was highly statistical significance relationship between socio-demographic characteristics of patients and their adherence to infection control precautions at homes. Conclusion: Regarding patients’ total adherence score to infection control precautions at home most of the patients were not adhered and more than one third of the patients did not do anything to adhere to infection control precautions at homes Recommendation: Providing Continuous educational programs for patients and their families about hepatitis C to avoid complications of hepatitis C

BACKGROUND Diagnosing blood-borne virus (BBV) infection is an essential first step in eliminating transmission and securing access to treatment amongst substance misusers. AIMS To determine the proportion of substance misusers presenting to hospital who undergo BBV testing and the factors influencing testing. METHODS A retrospective cross-sectional study was performed of patients presenting to two Sydney teaching hospitals with substance misuse diagnoses between January and April 2015. Proportions tested for human immunodeficiency virus, hepatitis C and hepatitis B previously and during the index hospitalisation presentation were examined. Multivariable analysis was performed to determine factors associated with testing. RESULTS Of 239 patients, 47 (19.7%) had a documented BBV at baseline. Of those with unknown BBV status, 29 (12.8%) had undergone some attempt at testing during presentation; 3.1% had their hepatitis B immunity assessed. Factors associated with an increased likelihood of testing during presentation included documented injecting drug use (odds ratio (OR) 15.14; 95% confidence interval (CI) 4.21-54.50; P < 0.001), admission under a physician (OR 11.79; 95% CI 2.82-49.40; P = 0.001) and admission on a Friday (OR 4.46; 95% CI 1.28-15.48; P = 0.02). Patients who had had more than one previous admission in the preceding 6 months (OR 0.24; 95% CI 0.078-0.73; P = 0.01) or a length of stay of 1 day or less (OR 0.17; 95% CI 0.032-0.87; P = 0.033) were less likely to be tested. CONCLUSION Despite the high baseline prevalence of BBV infections in the population, there were many missed opportunities for BBV testing. We found patient-, admission- and clinician-level barriers that could be addressed to enhance BBV testing uptake.

Blood borne virus (BBV) infection in adults involved in high risk behaviour is well recognized. There are limited reported data on young people involved in high risk behaviour. A descriptive questionnaire was used to ascertain risk behaviour at the Young People’s Substance Misuse Service (Birmingham). Data collection included risk behaviour and serological tests for hepatitis B, C and HIV. Sixty-five of one-hundred three (63%) young people participated; 37/65 male; age range 13.9–18.9 (median 17.4 years). Risk behaviour included 6 intravenous drug, 58 cannabis, and 61 had sexual partners, of whom 52 (85%) engaged in unprotected sex. Sixty-five participants were negative for BBV infection: 9 were HBV immune. HB vaccination was not available at the centre (for

Background:\ud The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013.\ud \ud Aim:\ud To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing.\ud \ud Method:\ud A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013).\ud \ud Results:\ud A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting.\ud \ud Conclusion:\ud Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services.

Introduction Chronic hepatitis C virus infection (HCV) is a major cause of end stage liver disease. With advances in anti-viral therapy there is an opportunity to ‘eliminate’ HCV from the UK. HCV is common in incarcerated individuals (~7% of UK inmates are anti-HCV Ab positive). Increasing diagnosis and treatment of HCV in prison is a priority in order to achieve ‘elimination’. However, HCV testing rates in UK prisons are low (4%). In order to increase diagnosis and treatment of HCV in the North East of England (NEE) prisons we implemented: 1. A universal offer of blood borne virus testing (UBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; 2. Prison Telemedicine clinics within NEE Prisons to increase HCV treatment rates. Aim To review results of the implementation of UBBVT in Durham Prison (DP) and the impact of the introduction of Telemedicine HCV treatment clinics in Northumberland Prison (NP). Results UBBVT was implemented at DP, the major remand prison in NEE, in Mar 2016. From Mar 2016 to Feb 2017 3309 BBVT offers were made in total with 2831 of the 4280 (66%) new receptions (NRs) were offered BBV testing, compared with 164 of 7,000 NRs (2.3%) in 2013–14. 1495 (53% of offered; 35% of all NRs) NRs accepted BBV testing, of whom 95 (6.4%) were anti HCV antibody positive. Of these 47 (49.5%) were HCV RNA positive confirming active infection (3.1% of all tested). Common reasons for non-acceptance of the test were ‘doesn’t want it’ (54%) and ‘already had test’ (37%). Consultant-led Telemedicine clinic (TC) with nurse in-reach was implemented in NP (a medium sentence prison) in Aug 2015. Between Aug 2015 &amp Oct 2017 80 individuals were seen in the TC. Of those seen in the TC, 57 (71%) commenced anti-HCV treatment. In 1 year prior to implementation of the TC, only 6 patients received HCV treatment. Overall, satisfaction with the TC among the prisoners was very high (80% good or excellent). Moreover, this is very cost effective with reduced cost of prisoner movement (Est £500/hospital visit). SVR and adherence data will be presented. Conclusions A universal offer of BBV testing to prisoners at reception to prison can substantially increase testing rates and lead to many new diagnoses of HCV. Prison telemedicine clinics with nurse-led in-reach offer a cost effective and efficient method of treating HCV in the prison environment.

With recent advances in antiviral therapy, there is an opportunity to eliminate hepatitis C virus (HCV) from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti-HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed to assess the impact implementation of: (a) A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; (b) Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2831 of 4280 (66%) new receptions were offered blood borne virus (BBV) testing. Of these, 1495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4%-4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n = 29), 100% achieved sustained virological response. In the year prior to implementation, only four patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high-prevalence population.

BACKGROUND:In 2015, Milton Keynes (MK) Council waste management team shows an increase in the numbers of abandoned used needles being found across MK. MK is an area of high Human Immunodeficiency Virus (HIV) prevalence and high Hepatitis C (HCV) in People Who Inject Drugs (PWID), the overriding concern was for the safety of the public. METHODS:Analysis of data collection to understand the scale and spread of the problem, preventing/ reducing the incidence of abandoned needles and looking at access to the designated Drug Dependency Unit (DDU) and the Blood Borne Virus (BBV) service. Through data mapping, hotspot areas of used needles abandonment were analysed. RESULTS:Peak needle stick finds were in March and June 2015 mainly in areas of social deprivation and marginalisation where designated needle exchange points were identified. 174 reports of abandoned needles were reported between January 2015 and November 2015 with a total of 2379 individual needles. 87% of the total numbers of needles were found in just 8 estates. CONCLUSION:Tackling the issue of abandoned needles effectively should be done through a targeted, multi-agency approach. Reductions in needlestick abandonment can be strengthened through improving access to needle exchange points, DDU and BBV services, delivering high-quality harm reduction interventions and using data mapping in order to identify and target hot spot areas.

• This is the first study in Scotland to offer testing for all three blood-borne viruses (BBVs) to new patients in primary care.

Objective: To identify components of a proposed blood-borne virus (BBV) population screening programme and its associated consent procedure that both the public and health practitioners (HPs) would find acceptable. The proposed BBV screening system would aim to reduce late diagnosis of BBVs and be used in patients undergoing routine blood tests, aided by risk stratification software to target individuals at higher risk of infection. \ud \ud Design: A Delphi technique was used to build consensus among two separate groups, public participants and HPs in England. \ud \ud Methods: A survey incorporating vignettes was developed, with input from an external panel of experts. Over three rounds, 46 public participants and 37 HPs completed the survey, rating statements on a four-point Likert scale. The survey covered issues around stigma and sensitivity, the use of risk stratification algorithms and 'limited' patient consent (ie, preinformed of the option to 'opt-out'). Consensus was defined as >70% of participants agreeing or disagreeing with each statement. \ud \ud Results: Consensus was achieved among both groups in terms of acceptability of the screening programme. There was also consensus on using patient data to risk-stratify screening algorithms and the need to obtain some form of consent around the time of drawing blood. \ud \ud Conclusions: This study found that the special protected status of HIV in England is no longer deemed necessary today and hinders appropriate care. We propose that a novel 'limited consent procedure' could be implemented in future screening programmes.