confirmed that in HCV-3 cirrhotics, the minor G allele of rs6834314 reduces the risk of exceed the LSM 25 kPa cut-off more than nine fold (OR 0.11, 95%CI 0.02–0.62, p = 0.013) together with age (OR 0.9, 95%CI 0.76–0.99, p =0.03) and independently of gender, BMI, ALT, diabetes and PNPLA3 rs738409 polymorphism. Conclusion: In untreated HCV-3 cirrhotics, the rs6834314 variant was associated with lower LSM values suggesting that the correlation between HSD17B13 SNP and liver disease severity might be triggered mainly by virus-mediated steatosis. THU354 The impact of universal access to DAA and real-world treatment outcome amongst genotype 3 hepatitis C virus-infected prisoners Yu Jun Wong 1 , Fria May Gloriba Manejero 1 , Kim Wei Lim 1 , Sin Yoong Chong 1 , Linn War Mai 1 , Rahul Kumar 2 , Eng Kiong Teo 1 , Jessica Tan 1 , John Chen Hsiang 3 , Prem Harichander Thurairajah 1 . 1 Changi General Hospital, Gastroenterology & Hepatology, Singapore, Singapore; 2 Changi General Hospital, Gastroenterologyand Hepatology, Singapore, Singapore; 3 Sengkang General Hospital, Gastroenterology & Hepatology, Singapore, Singapore Email: eugene.wong.y.j@singhealth.com.sg Background: Despite the disproportionally high prevalence of hepatitis C virus (HCV) amongst prisoners, eradication remains challenging due to logistic and financial barriers. Genotype-3 (GT3) was considered difficult to treat even with the introduction of direct- acting antiviral (DAA). To date, the real-world treatment outcomes of GT3 HCV prisoners with DAA remains limited. Objective: To compare the real-world efficacy of DAA and the impact of universal access of DAA among GT3 and non-GT3 HCV prisoners. Method: 307 HCV prisoners treated with DAA in our specialized liver clinic from 2013–2019 were prospectively included in a treatment database and sustained virological responses at 12 weeks (SVR12) were compared. Universal access to pan-genotypic DAA was commenced in 2019. GT3 HCV patients received either 12 weeks of sofosbuvir/daclatasvir and ribavirin (SOF/DAC/Riba) or 12-weeks of sofosbuvir/velpastavir (SOF/VEL). Genotype 1 (GT1) patients receive HARVONI, VIEKIRA PAK or SOF/VEL for 12 weeks. Ribavirin was added for patients with clinically significant portal hypertension, prior treatment or hepatocellular carcinoma. Results: GT3 (57.7%) was the commonest genotype followed by GT1 (39.7%) amongst prisoners. Patients were mostly male (93.2%) and cirrhotic (52.1%), with a mean age of 52.5 years. The majority received SOF/VEL +/- ribavirin (58.9%) followed by VIEKIRA PAK +/- ribavirin (23.2%) and SOF/DAC/Riba (14.7%). The overall SVR12 based on intention-to-treat (ITT) and modified ITT analysis for GT3 and GT1 were 96.9%, 99.3% and 98.2%, 99.2%, respectively (Figure 1). While virological failure occurred in SOF/DAC/Riba (n = 1) and VIEKIRA PAK (n = 1), there was no virological failure using SOF/VEL regimen. The SVR12 was similar between GT3 and non-GT3 prisoners after adjusted to platelet count, PT and baseline viral load (99.4% vs 99.2%,95%CI: 0.03–76.7). Compared to the year 2018, universal access to pan-genotypic DAA alone significantly improved treatment access among HCV prisoners by 130% and allowed more non-cirrhotic HCV prisoners to be treated in 2019 (62.1% vs 42.6%, p < 0.001). Conclusion: We demonstrated that GT3 HCV prisoner is no longer a difficult-to-treat cohort in the pan-genotypic DAA era, and high SVR12 can be achieved in the real-world setting. Our result shows that universal access to DAA among HCV prisoners is an impactful strategy for HCV micro-elimination in this cohort. THU355 Hepatitis C reflex testing in Spain in 2019: a storyof success Federico Garcia Garcia 1 , A. Aguilera 2 , José Luis Calleja Panero 3 , Jose María Eiros 4 , Antonio Javier Blasco Bravo 5 , Pablo Lazaro 5 , Francisco Javier Garcia-Samaniego Rey 6 , Javier Crespo 7 . 1 Hospital Universitario Clinico San Cecilio. Instituto Investigación IBS.Granada, Microbiology, Granada, Spain; 2 Complejo Hospitalario Universitario de Santiago. Xerencia de Xestion Integrada de Santiado de Compostela., Servicio de Microbiología, A Coruña, Spain; 3 Hospital Universitario Puerta de Hierro., Aparato Digestivo, Madrid, Spain; 4 Hospital Universitario Rio Hortega, Servicio de Microbiologia, Valladolid, Spain; 5 Investigador independiente en Servicios de Salud, Madrid, Spain; 6 Hospital Universitario La Paz. IdiPAZ. CIBERehd., Servicio de Aparato Digestivo, Madrid, Spain; 7 Hospital Universitario Marqués de Valdecilla. IDIVAL. Facultad de Medicina, Universidad deCantabria, Santander, Spain Email: fegarcia@ugr.es Background and Aims: For exploring the diagnosis situation of hepatitis C virus (HCV) infection in Spain, in 2017 we conducted a survey across hospital diagnostic laboratories, finding that only 31% of them were providing reflex testing (HCV antibodies and HCV RNA on the same sample). As a consequence, the Spanish Societies of Infectious Disease & Clinical Microbiology (GEHEP-SEIMC), Hepatology (AEEH, SEPD) and the Viral Hepatitis Elimination Alliance (AEHVE) signed a position document with recommenda- tions on reflex testing. In addition, training and dissemination activities were developed by the mentioned organizations to promote reflex testing implementation in the Spanish hospitals. Our aim was to evaluate how reflex testing has been implemented in Spain, and to gain knowledge on access to new diagnostic strategies across hospital Spanish laboratories. Method: Cross-sectional study with data collection through a survey addressed to hospitals of the Hospitals National Catalogue with the following inclusion criteria: 1) general hospital (monographic, e.g., psychiatric hospitals are excluded); 2) with at least 200 beds; and 3) public, or teaching hospital if private. A questionnaire with the variables of interest, designed by a scientific committee composed of hepatologists and microbiologists, was sent to the selected hospitals. The fieldwork was carried out in September and October 2019. Results: In 2019, 161 hospitals were surveyed, and 129 (80,1%) responded, vs 90/160 (56,3%) who responded in 2017 (p < 0,001). Reflex testing is now implemented in 89% of Spanish hospitals (115/ 129); in 2017 only 31% (28/90; p < 0,001) performed reflex testing. The number of hospitals that implemented alert systems to communicate HCV active chronic infection rose from 68,9% (2017) to 86,0% (2019) (p = 0,002). Access to dried blood spot (DBS) and/or point of care testing in 2019 in Spain was: 10,9% for antibody testing from DBS; 15,5% for RNA testing from DBS; 36,4% for point of care (POC) RNA testing; 0,85% for antibody POC testing. Overall, 43,4% of Spanish hospitals has access to at least one of DBS/POC testing strategies. Conclusion: In Spain, the proportion of hospitals that perform reflex testing for chronic HCV infection has significantly increased to 89% in 2019. Recommendations, training and dissemination measures performed since 2017 may be responsible for this increase. However, in 2019 new screening strategies such as DBS and POC testing are poorly implemented in Spanish hospitals. POSTER PRESENTATIONS S313 Journal of Hepatology 2020 vol. 73 | S123–S400