to all those tested. All HCV RNA positive were offered a clinic review 10 days after testing to commence treatment with a pangenotypic antiviral. Results Of the 307 residents in the prison at the time of the event, 305 (99%) accepted BBV testing. A total of 98 (32%) were HCV antibody positive, of these 23 were HCV RNA detected (23% of HCV Ab pos and 8% of all tested) in keeping with active HCV. One resident was HIV positive (known) and 4 had positive syphilis serology. None were HBsAg positive.

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... Of the 23 HCV RNA positive residents, 3 were already on antiviral treatment, 17 commenced antivirals and 3 were released before treatment could be initiated (contact planned in the community). One patient was suspected of having cirrhosis. Of the 75 HCV antibody positive but RNA negative residents 40 (53%) were known to have received antiviral treatment already and achieved sustained virological response and 10 (13%) were currently on treatment. Feedback from residents and staff on the way the HITT was conducted was good. A point of care HCV RNA testing machine is now being used to identify HCV infection among new residents to try and maintain 'elimination'. Conclusions A high intensity test and treat weekend coupled with quick access to antiviral treatment for HCV is a highly effective way to 'eliminate' HCV within a prison. However, these sessions require meticulous planning in order to be successful. Acknowledgment All the staff and residents of HMP Low Newton and the Hepatitis C Trust. Introduction Iron deficiency anaemia (IDA) without additional gastrointestinal (GI) symptoms is common. Due to the association with GI malignancy, investigation of the upper and lower GI tract is recommended in older adults with IDA. However, rates of specific diagnoses are incompletely defined, and criteria to permit rationalisation of investigation are unclear. The yields of repeated investigation and of testing for coeliac disease (CD) are also uncertain. Methods Cohort study derived from a prospectively collected referrals database of patients with IDA and suspected cancer from two UK hospitals in a single NHS Trust over a 52month period. Results 5702 consecutive referrals were assessed and, after exclusions, 2035 patient referrals for IDA without additional GI symptoms were assessed. 1118 (54.9%) were women; median age was 74 years (IQR 66-81). Cancer was diagnosed in 147 (7.2%) and luminal GI cancer in 120 (5.9%). For luminal cancers, the site was colorectal in 103 (5.0% of all patients), gastric in 11 (0.5%) and oesophageal in 6 (0.3%). Other diagnoses made in !1% were benign upper GI ulceration in 77 (3.8%), ulcerative colitis in 35 (1.7%), and CD in 21 (1.0%). No major diagnosis was found in 1706 (83.8%). Those with luminal cancer were older (78 vs 74 years; p<0.001), more anaemic (Hb 89 vs 101 g/L; p<0.001), had higher CRP (38 vs 5.8 mg/L; p<0.001), lower ferritin (14 vs 15 mg/L; p=0.012), lower transferrin saturation (7 vs 9%; p<0.001), lower MCV (79.8 vs 83.2 fL; p<0.001) and lower MCHC (296 vs 302 g/L; p<0.001), and were more likely to be male (53.7% vs 44.5%; p=0.048). The single most discriminatory variable for predicting luminal cancer was haemoglobin deficit (AUROC 0.64). After multivariable analysis, age (RR 1.56/10 years, 95%CI 1.23-1.99, p<0.001); elevated CRP (RR 1.10/10 mg/L, 1.07-1.14, p<0.001); lower MCV (RR 0.47/10 fL, 0.31-0.71, p<0.001; and male sex (RR 1.92, 1.16-3.18, p=0.011) were significant for risk of malignancy. Of 142 patients (7.0%) referred more than once within the study period, just two had luminal gastrointestinal cancer (1.4%; p=0.027 vs first referrals). Only 21 (1.4%) of 1485 patients who underwent duodenal biopsy had histology compatible with CD; for serology, 7 of 557 patients (1.3%) were positive. Conclusions This study, to our knowledge the largest such cohort yet reported, provides data that will aid both patient counselling and the development of referral and investigation pathways for IDA. Repeated investigation of IDA and duodenal biopsy for CD in IDA without GI symptoms have limited yields.