2898. Achieving Hepatitis C SVR12 of 95% in Mono-Infected Patients with Severe Comorbidities Using Volunteer Staff and Minimal Clinic Visits and Phlebotomy

BACKGROUND: HCV is the most common chronic bloodborne infection in the United States with an estimated 3.5 million infected. With direct-acting antivirals, cure can be achieved in 8 to 12 weeks. To achieve WHO elimination targets by 2030 (>90% reduction in incidence) requires increased detection, access to care, and simpler treatment protocols that patients, challenged by substance use and mental health disorders, can readily complete. METHODS: In 2016, Wake County, NC began HCV testing at 32 sites finding prevalence >10% at 5 shelters and drug treatment centers. An adapted simplified HCV treatment protocol, used in the high prevalence settings of Ukraine and Burma, was implemented at the Open Door Clinic – a free clinic for uninsured persons living in poverty in Wake County. After initially using genotype-specific therapy, we switched to pan-genotypic sofosbuvir/velapatisvir (SOF/VEL) for 12 weeks. Clinic visits were limited to pre-treatment and 12 weeks after treatment completion. Patients were contacted weekly via text to check on their health and adherence. RESULTS: Thirty HCV mono-infected patients have initiated treatment including 9 women. 21 were infected by IDU, 5 by transfusion, 3 by sex with an infected partner, and 5 have unknown risk. In genotype (GT) testing 22 have GT1, 3 GT 2, and 4 GT3. Major comorbidities include 24 with current or recent IDU, alcohol dependency, psychotic depression or schizophrenia, or missing all medical appointments other than the HCV. Twenty-seven of 30 have completed their prescribed course of HCV therapy and 20 have achieved an SVR at 12 weeks. The 1 patient who failed was admitted to the hospital 4 times in the first 6 weeks of treatment and did not take his medication consistently. An additional 2 remain on treatment and 6 are awaiting results of testing done at 12 weeks post-therapy completion. One patient died within 2 weeks of initiating therapy due to a perforated duodenal ulcer. CONCLUSION: Using targeted on-site HCV testing, we identified high prevalence sites. Implementing a simplified HCV treatment program reduces patient and clinic burden and resulted in 95% achieving SVR12 despite severe comorbidities. Expansion of this program to other clinics in Wake County is underway. DISCLOSURES: All Authors: No reported Disclosures.