SAT344 No restrictions should be placed on future treatment for patients who discontinue DAAs on their first or second attempt. A real world experience from the TraP HepC initiative in Iceland Sigurdur Olafsson 1,2 , Thorvardur J. Löve 2,3 , Ragnheidur H. Fridriksdottir 1 , Thorarinn Tyrfingsson 4 , Valgerdur Runarsdottir 4 , Ingunn Hansdottir 4,5 , Ottar M. Bergmann 1 , Einar S. Björnsson 1,2 , Birgir Johannsson 6 , Bryndis Sigurdardottir 6 , Arthur Löve 2,7 , Guðrún Erna Baldvinsdóttir 7 , Gudrun Sigmundsdottir 8 , Ubaldo Benitez Hernandez 3 , Maria Heimisdottir 9 , Magnús Gottfredsson 2,3,6 . 1 Landspitali University Hospital, Department of Gastroenterology and Hepatology, Reykjavik, Iceland; 2 University of Iceland, Faculty of Medicine, School of Health Sciences, Reykjavik, Iceland; 3 Landspitali University Hospital, Department of Science, Reykjavik, Iceland; 4 SAA National Center for Addiction Medicine, Reykjavik, Iceland; 5 University of Iceland, Faculty of Psychology, School of Health Sciences, Reykjavik, Iceland; 6 Landspitali University Hospital, Department of Infectious Diseases, Reykjavik, Iceland; 7 Landspitali University Hospital, Department of Virology, Reykjavik, Iceland; 8 Chief Epidemiologist, Directorate of Health, Reykjavik, Iceland; 9 Icelandic Health Insurance, Reykjavik, Iceland Email: sigurdol@landspitali.is. Background and Aims: To achieve elimination of hepatitis C virus (HCV) as a major health threat, the World Health Organization (WHO) has set treatment service coverage targets of 90% diagnosis and treatment of 80% of eligible patients by the year 2030. The TraP HepC program in Iceland aims to eliminate domestic transmission of HCV by offering treatment to all known cases, focusing on those most likely to transmit. To reach the WHO targets, strategies are needed for those patients who discontinue or otherwise fail treatment. Method: Starting in 01/2016 all HCV positive patients are offered direct acting antivirals (DAAs). People who inject drugs (PWID), prisoners, and patients with advanced liver disease are prioritized. Patients who discontinue treatment and remain viraemic as well as reinfected patients are reengaged in care and offered retreatment. Here we analyzed engagement in care and sustained virologic response rates at ≥12 weeks post treatment (SVR≥12) for all individuals who commenced treatment from Jan 2016 to Jan 2019. Results: Treatment was initiated for 718 individuals, 98% of the eligible (HCV PCR positive) patient population of whom 703 patients (98%) gave consent for study participation. Mean age was 44 years (IQR 34–54), males 474 (67%). The most common route of infection was injection drug use (IDU, 85%), 33% reported recent (within 6 months) IDU; 7% were homeless, and 5% incarcerated. Stimulants were preferred by 85% of PWID, opioids by 13%. Overall, 9% were on medication assisted therapy for opioid use disorder. Of 703 who initiated treatment, 650 (92.5%) completed treatment with PCR results ≥12 weeks available for 632. A total of 603 (95%) were PCR negative and 29 positive (12 reinfections,12 relapses, data pending for 5). Of 53 who discontinued treatment, SVR>12 data are available for 47 of whom 25 (53%) are PCR negative and 22 positive. Overall, if patients with no SVR>12 results are counted as failures, the cure rate for first DAA treatment was 89%. During the period, a second treatment course was initiated in 70 individuals, 66 completed treatment, and SVR12 results are available for 63. A total of 60 (95%) were cured and 3 PCR positive. Data is missing or pending for two, one died before reaching SVR≥12. Of the 4 (6%) patients who discontinued treatment during round 2, three remained positive and one achieved SVR≥12. In total 7 patients received a third treatment round, of whom 6 completed treatment. All 6 completers reached SVR≥12, but the remaining patient who discontinued had persistent viraemia. Conclusion: Patients who discontinue treatment on the first and second attempt are highly likely to complete therapy if they reengage in care for their second or third attempt. Their cure rates are comparable to those who complete the course on their first attempt. No restrictions for future treatment should be placed on patients who discontinue DAAs on their first or second attempt. SAT345 National survey among people who use drugs (PWUD) on opioid substitution treatment (OST) on their knowledge of hepatitis C virus (HCV) infection and barriers for treatment in Bulgaria Marieta Simonova 1 , Alexander Kantchelov 2 , Georgi Vasilev 3 , Borislava Peeva 4 , Lyuba Hadzhiyska 5 , Malin Stoyanov 6 , Daniela Alexieva 3 , Boryana Ekova 7 , Emil Grashnov 8 , Alexander Angelov 9 , Marian Silyanovski 9 , Georgi Koev 10 , Tinka Nacheva 11 , Mira Altankova 12 , Temenujka Mateva Dechkova-Novakova 13 , Faniq Taneva 14 , Dora Atanasova 15 , Velislava Martinova 16 , Margarita Novoselska 17 , Boyanka Kitova 18 , Dimitar Vasilev 19 , Dian Hursafov 20 , Jechka Parusheva 21 , Antoaneta Kumbieva 22 , Adriana Solakova 23 , Rumen Dimitrov 24 , Cvetana Stoykova 2 , Maria Dobreva 2 , Lidia Gencheva 24 , Ana Tomanova 23 , Todor Kondurdzhiev 25 , Slava Pavlova 1 , Tanya Hadzhiolova 1 , Lyudmila Mateva 26 , Krum Katzarov 1 . 1 Military Medical Academy, Clinic of Gastroenterology, Sofia, Bulgaria; 2 ET Ambulance for private practice for psychiatric specialised help “Alexander Kantchelov”, Sofia, Bulgaria; 3 MC “Horisont”, Sofia, Bulgaria; 4 State psychiatric hospital for drug and alcohol addiction, Sofia, Bulgaria; 5 AGPSPP - Phylipoplis OOD, Plovdiv, Bulgaria; 6 Ambulance for group practice and specialised medical help “Doverie za zdarve”, Sofia, Bulgaria; 7 ET IPCMP dr Boryana Ekova, Sofia, Bulgaria; 8 Center for Mental Health - Sofia district EOOD, Sofia, Bulgaria; 9 AICPMP dr Alexander Angelov EOOD, Sofia, Bulgaria; 10 GPASH Koev and all. EOOD, Sofia, Bulgaria; 11 AGPSMP dr Tinka Nacheva, Stara Zagora, Bulgaria; 12 ASMPP Nadejda EOOD, Sofia, Bulgaria; 13 Center for mental health Ruse EOOD, Ruse, Bulgaria; 14 Dr Faniq Taneva AIPSMP EOOD, Plovdiv, Bulgaria; 15 State psychiatric hospital Pazardjik, Pazardjik, Bulgaria; 16 ET Velislava Martinova ASMP IPP, Lovech, Bulgaria; 17 Center for mental health dr P. Stanchev - Dorbrich EOOD, Dobrich, Bulgaria; 18 Medical Center Zdrave OOD, Vratza, Bulgaria; 19 Medical center Terapia 2007 AASMH OOD, Varna, Bulgaria; 20 MBAL Sveta Marina EAD, Varna, Bulgaria; 21 Medical center Alfeus AISMP OOD, Burgas, Bulgaria; 22 ET Dr Antoaneta Kumbieva IPSPMP, Burgas, Bulgaria; 23 VIA-Horisonti IPSMPP EOOD, Blagoevgrad, Bulgaria; 24 ASMP-P-IP-Kantchelov Vidin EOOD, Vidin, Bulgaria; 25 Medical University Sofia, Occupational Medicine Department, Biostatistics and Medical Information, Sofia, Bulgaria; 26 UMBAL Ivan Rilski, Clinic of Gastroenterology, Sofia, Bulgaria Email: simonova_m@yahoo.co.uk. Background and Aims: OST in Bulgaria is provided only in OST centers (OSTC). Currently, there are 30 OSTC (5 state and 25 private) in 16 cities in the country with 3247 clients. HCV seroprevalence among PWUD is 68%. OST is not a contraindication for HCV treatment, however treatment rates among HCV – positive OST patients remain low. Only people with health insurance can receive HCV antiviral treatment. No other funding for treatment exists. The aim of the study was to investigate the knowledge of HCV infection and the barriers for treatment among PWUD on OST in Bulgaria. Method: A survey with multiple choice structured questionnaire (16 questions covering demography, epidemiology of drug use, HCV testing and treatment, barriersto treatment) was offered in all OSTC in Bulgaria. Questionnaires were anonymous, filled by the patients. Statistical analyses were done by Kolmogorov-Smirnov, Chi-Square, Mann-Whitney and Kruskal-Wallis tests. Results: From 01 May to 31 October 2019 1907 patients (58,7%) from 21 OSTC (70%) in 15 cities participated in the survey.1495 males/412 females, mean age 38,26 ± 5,78years/36,86 ± 6,85years (p < 0,001) completed survey. Mean duration of drug use in males/females −13,19 ± 6,11years/12,16 ± 6,47years (p < 0,001). HCV seroprevalence was 61,2%. 95,6% of PWUD have ever been tested for HCVAb. There was significant correlation between HCVAb testing and intravenous drug use (IVDUs) (p < 0,001): IVDUs were reported from 9,9% people in ≤3 months, 7,7% in ≤6 months, 8,9% in ≤12 months, 60,7% in ≥12 POSTER PRESENTATIONS S827 Journal of Hepatology 2020 vol. 73 | S653–S915