HCV in specific populations in certain sub-regions of Romania and link them to treatment right away after diagnosis. Method: We conducted a screening program by Gastroenterology specialists from 4 different Regions of Romania. Screening was offered to all patients admitted into the hospital Departments. We used rapid diagnostic tests, the positive HCVAb subjects were further evaluated for viral load and fibrosis and antiviral treatment was started immediately. A questionnaire with 17 questions was given at the time of testing in order to identify risk factors for HCV infection. Results: Between March and November 2019, 17497 persons were screened. Overall 1.45% had a positive HCV test, with the highest prevalence in Cluj (1.84%) and the lowest in Bucharest (1.26%). Patients found positive were older (64.9 ± 12.8 vs 52.2 ± 16.8years, p < 0.0001), from rural areas (2.36% rural vs 1.17% urban, p < 0.0001), with a higher prevalence in the Gypsy population (3.67% Gypsy vs 1.46% Romanians and 0.76% Hungarians, p =0.16). In patients with positive HCV the following risk factors were identified in a significantly higher proportion: previously known infection with HBV/HDV, blood transfusions and unsafe abortions before 1990, multiple surgical interventions and multiple hospitalizations during lifetime, multiple stomatology interventions and IV drug users. Conclusion: During the HEPC A.L.E.R.T. micro-elimination program in Romania, a viremic prevalence of 1.45% was detected, significantly lower compared to the previous reported data. Testing all out- and in- patients attending different departments of regional hospitals might be an efficient approach of screening and link to care cascade of hepatitis C management. SAT327 What is required for achieving HCV elimination in Singapore? A modeling study Antoine Chaillon 1 , Prem Harichander Thurairajah 2 , John Chen Hsiang 3 , Natasha Martin 1 . 1 University of California San Diego, Medicine, San Diego, United States; 2 Changi General Hospital, Gastroenterology, Singapore; 3 Sengkang General Hospital, Gastroenterology, Singapore Email: achaillon@ucsd.edu. Background and Aims: Singapore is a country with a low general population HCV seroprevalence (0.37–0.54%). The vast majority of hepatitis C virus (HCV) infection in Singapore is among those with a history of injecting drug use (IDU, 45% of whom having history of current or past HCV infection), yet what is required to achieve the World Health Organization (WHO) HCV elimination targets (80% incidence reduction, 65% mortality reduction by 2030) is unknown. We model the intervention scale-up and targeting required to achieve WHO targets in Singapore. Method: A dynamic model of HCV transmission and progression among those with a history of IDU was calibrated to Singapore, a setting with approximately 11,000 people with a history of IDU in 2017 and recent declines in IDU (based on a decline in arrests of new heroin users by ∼30%/year from 2012–2018), among whom 45% are seropositive for HCV. We projected HCV treatment scale-up from 2019 required to achieve the WHO targets with varying treatment targeting scenarios (no prioritization, prioritize PWID, prioritize cirrhotics, prioritize PWID and cirrhotics). We explored the impact of opiate substitution therapy (OST) implementation (to 40% among PWID) on treatments required. Results: In 2019 in Singapore, there were an estimated 3855 (95% CI:2635–5446) chronically HCV infected individuals with a history of IDU and 148 (95%CI: 87–284) incident HCV cases. To reach the HCV incidence target in Singapore, 272 (95%CI 187–384) treatments are required in 2019, totaling 2444 [95%CI 1683–3452] across 2019– 2030. By prioritizing PWID or PWID and cirrhotics, 60% or 30% fewer treatments are required, respectively, whereas the target cannot be achieved with cirrhosis prioritization. OST scale-up could reduce treatments required by 21–24% depending on treatment targeting. Achieving both WHO targets requires treating 631 (95%CI: 359–1047) in 2019, totaling 3816 (95%CI: 2664–5423) across 2019–2030. Similar 2019 treatments but fewer cumulative treatments are needed if prioritized to PWID and cirrhotics. Conclusion: HCV elimination is achievable in Singapore, but even in a setting of declining IDU requires immediate treatment scale-up among PWID. Combination harm reduction and treatment could reduce treatments required and provide additional benefits. SAT328 Hepatitis C virus screening of people with severe mental illness: a cost-effectiveness analysis François Girardin 1 , Chris Painter 2 , Natalie Hearmon 2 , Lucy Eddowes 2 , Stefan Kaiser 3 , Francesco Negro 4 , Nathalie Vernaz 5 . 1 Geneva University Hospitals, Medical Direction, Division of Clinical Pharmacology and Toxicology, Gene ̀ ve 14, Switzerland; 2 Costello Medical, London, United Kingdom; 3 Geneva University Hospitals, Adult Psychiatry Division, Gene ̀ ve 14, Switzerland; 4 Geneva University Hospitals, Divisions of Gastroenterology and hepatology and of Clinical pathology, Gene ̀ ve 14, Switzerland; 5 Geneva University Hospitals, Medical Direction, Finance Direction, Gene ̀ ve 14, Switzerland Email: nathalie.vernaz@hcuge.ch. Background and Aims: Hepatitis C virus (HCV) has been shown to be more common among people with severe mental illness (PSMI) than in the general population, with a prevalence ranging between 4.6– 17.4%, compared to 0.5–2.3% in the general population worldwide. Moreover, HCV prevalence in the PSMI populationwith a history of drug abuse screened at the Psychiatry department at the Geneva University Hospitals (Psy-HUG) was estimated to be 25.7%. We aim to assess a generalized screening approach of all PSMI, including those without a history of drug abuse with a prevalence of 3.49%. Method: Prevalences were estimated from unpublished anonymous data obtained from the HUG electronic patient record. The inclusion criteria were all patients hospitalized at Psy-HUG from January 2016 until July 2019 who were screened either for antibodies to HCV, or HCV RNA from 1990 onwards. To identify PSMI with a history of substance abuse, text data mining techniques employing natural language processing were used to search for terms such as ‘heroin’, ‘methadone’ or ‘cocaine’ in the patient electronic records. This study adapted a previously published cohort decision tree screening model to estimate the cost-effectiveness of routine PSMI HCV screening compared to the current risk-based screening approach (i.e. only PSMI with a history of drug abuse). Figure: Scatter plot of the probabilistic sensitivity analysis on the cost- effectiveness plan. Results: The total population size was 4,548. Generalized PSMI screening was found to be cost-effective compared to current risk- based screening, with a base-case incremental cost-effectiveness ratio of CHF 4,217 per quality-adjusted life year (QALY). The total incremental cost of the generalized screening programme at the POSTER PRESENTATIONS S818 Journal of Hepatology 2020 vol. 73 | S653–S915