ORAL PRESENTATIONS Conclusions: These results from the GBD 2010 suggest that while HIV/AIDS undeniably remains a key global health priority, mortality from viral hepatitis is higher than that of HIV/AIDS in the EU though this is not the case in other areas of Europe. The release of the GBD 2010 results provides a unique opportunity to set global and local priorities for health, and address previous imbalances in addressing the major preventable causes of human death, among which hepatitis B and C must clearly now be counted. O87 FEASIBILITY AND COST ANALYSIS OF COMMUNITY BASED HEPATITIS B SCREENING PROGRAMME IN SUB-SAHARAN AFRICA S. Nayagam1 , Y. Shimakawa2,3 , M. Lemoine1,2 , R. Njie2 , S. Tamba2 , U. D’Alessandro2 , T. Hallett4 , L. Conteh4,5 , M. Thursz1 . 1 Department of Hepatology, Imperial College London, St Mary’s Hospital, London, United Kingdom; 2 MRC Unit, The Gambia, Banjul, Gambia; 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 4 Department of Infectious Disease Epidemiology, 5 Centre for Health Policy, Imperial College London, London, United Kingdom E-mail: [email protected] Background and Aims: Chronic hepatitis B (HBV) is highly prevalent in West Africa, yet many remain undiagnosed. Screening aims to identify asymptomatic carriers and offer early treatment to reduce the risk of cirrhosis and liver cancer. We evaluated the cost-effectiveness of community-based screening for HBV. Methods: Community-based screening was performed in The Gambia using point-of-care (POC) HBsAg as part of PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa). An ingredientscosting approach was applied, using retrospective programme costs between 2011 and 2013. A health provider perspective was taken. Results: 5321 people in 47 areas (22 rural, 25 urban) were screened over 2-years, with 281 days dedicated to screening. Screening uptake was 72% among those eligible (>30 years). 450 (8.46%) of those screened tested positive for HBsAg, 82% of whom were linked into secondary care. Total screening programme cost was £34,403; including 41% ﬁeldworker salaries, 26% consumables (£0.95 per POC test) and 17% transportation. Cost per person screened was £6.47 and £76.45 per HBV positive case detected. This could be reduced to £4.40 per person screened and £52.03 per HBV positive case detected, if the intervention was delivered using community health workers (CHW) rather than ﬁeld workers. Conclusions: Community-based screening for HBV is feasible and has low costs that are comparable with those of HIV screening programmes in sub-Saharan Africa. The trial setting likely overestimates actual costs of a routine screening programme. Even lower cost may be achievable by using CHWs for intervention delivery, integrating HBV screening with other public health interventions and using locally sourced consumables. O88 CHARACTERISTICS OF UNDIAGNOSED HBV OR HCV CHRONICALLY INFECTED POPULATION IN FRANCE: A NEED FOR RECONSIDERING TESTING STRATEGIES C. Brouard, Y. Le Strat, J. Pillonel, C. Larsen, C. Semaille. Infectious Diseases Department, French Institute for Public Health Surveillance (InVS), Saint-Maurice, France E-mail: [email protected] Background and Aims: With HCV and HBV therapeutic advances, effective screening is required. We aimed to estimate proportion, number and characteristics of undiagnosed HBV and HCV chronically infected population in France where the prevalence of HBV and HCV chronic infection is low (respectively, 0.65% and 0.53%). Methods: Through a random sample of 14,416 adult beneﬁciaries of the National health insurance system with serum samples and S36 data on demographic characteristics, risk factors and awareness of HBV/HCV infection, we estimated the proportion of undiagnosed HBV and HCV chronic infection in 2004. Results: Positive HBsAg was undiagnosed in 55% (95% CI:31–77%), corresponding to 154,956 people (95% CI:87,988–221,923), among whom 81% were males. Undiagnosed men were 18–39 and 40–59 years old in 43% and 47% and were born in low HBV endemic countries in 65%. Undiagnosed women were younger (18–39 years: 63%) and mainly born in moderate or high HBV endemic countries (92%). Proportion of undiagnosed HCV RNA positive was estimated at 43% (95% CI:29–59%), corresponding to 100,868 people (95% CI:58,834– 143,202), among whom 45% were males. Undiagnosed men were 18–39 and 60–80 years old in 36% and 41%. Undiagnosed women were older, aged of 60–80 in 72%. Overall, undiagnosed cases were mainly born in low HCV endemic countries. Natural mortality and incidence data will be further applied to update numbers of undiagnosed population. Conclusions: Despite the French action plans for prevention of viral hepatitis implemented since 2000 and the highest screening rate in Europe, improving testing effectiveness is still crucial in France to combat the silent epidemic of viral hepatitis. O89 IMPACT OF NEW DAA-CONTAINING REGIMENS ON HCV TRANSMISSION AMONG INJECTING DRUG USERS (IDUS): A MODEL-BASED ANALYSIS (ANRS 12376) A. Cousien1,2 , V.C. Tran3 , M. Jauffret-Roustide4,5 , S. DeufﬁcBurban1,2,6 , J.-S. Dhersin7 , Y. Yazdanpanah1,2,8 . 1 IAME, UMR 1137, INSERM, 2 IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cit´e, Paris, 3 Laboratoire Paul Painlev´e UMR CNRS 8524, UFR de Math´ematiques, Universit´e des Sciences et Technologies Lille 1, Cit´e Scientiﬁque, Villeneuve d’Ascq, 4 Institut de Veille Sanitaire, Saint-Maurice, 5 CERMES 3, Centre de Recherche M´edecine, Sciences, Sant´e, Sant´e Mentale et Soci´et´e, (INSERM U 988 Universit´e Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, 6 Inserm U 995, Universit´e Lille 2 – Lille Nord de France, Lille, 7 Universit´e Paris 13, Sorbonne Paris Cit´e, LAGA, CNRS, UMR 7539, Villetaneuse, 8 Service des Maladies Infectieuses et Tropicales, Hˆ opital Bichat Claude Bernard, Paris, France E-mail: [email protected] Background and Aims: HCV seroprevalence remains high among IDUs in France. With the arrival of more efﬁcacious and tolerable treatments, we assessed the impact of interventions at different levels of the cascade of care on prevalence and incidence of the disease in a French IDU population. Methods: We used a mathematical model to simulate HCV transmission and natural history of 10,000 IDUs for 10 years (initial prevalence=42.8%). Seven strategies were investigated, considering improvement of testing, adherence to care/treatment, and earlier treatment initiation (table) in three different scenarios regarding the the average number of injecting partners/IDU: 3, 6 and 15 (initial incidence = 0.065, 0.055 and 0.069 respectively). Results: Ten years after initiation of these strategies in France, we obtained similar prevalence and incidence estimates with strategies 1 to 5, ranging from 28% to 33% and from 0.016 to 0.024 respectively (table). At 10 years, strategy 6 (earlier treatment initiation) reduced by 2-fold prevalence and incidence estimates compared to strategies 1 to 5. Adding improvements in testing, linkage to care and adherence to care and treatment (i.e.; strategy 7) reduced HCV prevalence and incidence by an additional 30% when compared to strategy 6. Conclusions: Our analysis suggests that with DAA-containing regimens, earlier treatment will have an important impact on the HCV transmission among IDUs in France, which will be even more important if implemented in combination with ambitious testing, Journal of Hepatology 2014 vol. 60 | S23–S44