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Background Increasing rates of hepatitis C virus (HCV) infection are directly linked to the opioid and intravenous drug (IVD) epidemic. White and rural young adults have been affected disproportionately and most are unaware of their status. However, the CDC recommends HCV screening in persons born between 1945 and 1965 (baby boomers) with screening on others only based on exposures, behaviors, or comorbid conditions. Increased identification of affected individuals is the first step toward eradication of HCV infection Methods A prospective, observational study design was employed. We evaluated data collected between May 2016 to December 2017 from adults seen in the primary care, hospital, and emergency department settings at a large urban-based healthcare organization, located in an area with a high prevalence of intravenous (IV) drug use. Descriptive analyses followed by multivariable logistic regression to identify risk factors associations amongst age groups (1. general adult population, ages 18–52 years; 2. baby boomers ages 53–73 years; and 3. elderly age >74 years) were performed. Results A total of 59,563 patients were evaluated with a screening antibody. Unadjusted, the general adult population was more likely to have an AB positive screen (7.2% vs. 3.5% and 3.6% respective, P < 0.001), be RNA positive (4.9% vs. 1.7% and 1.5% respective, P < 0.001), and be Hispanic (3.3% vs. 1.1% and 0.8% respective, P < 0.001), while less likely to be a male (16.2% vs. 43.2% and 47.4%, P < 0.001). Adjusted (for pregnancy, gender, race and ethnicity) the general adult population is at increased odds of having an RNA positive test (OR = 4.4, 95% CI 3.7–5.0, P < 0.001) and an AB positive (OR = 2.9, 95% CI 2.2–3.9, P < 0.001), when compared with baby boomers Conclusion Efforts should be targeted to increase screening in younger cohorts as HCV is more prevalent in that group age. In areas affected by the opioid epidemic, revision of policies will decrease the gap toward elimination of HCV and universal screening will help to de-stigmatize this infection. Further, cost-efficiency studies will help inform policy makers of the best strategies to reduce transmission and increase linkage to care as next steps toward closing the gap in elimination of HCV infection Disclosures M. Rose, Gilead: Project Manager for Grant Funded Research, Norton received a grant from Gilead. The grant covers the salary. C. Espinosa, Gilead: Grant Investigator, Grant recipient; AstraZeneca: Investigator and Speaker’s Bureau, Research grant and Speaker honorarium; Cempra: Investigator, Research grant; The Medicines Company/ Melinta Therapeutics: Investigator, Research grant; Regeneron Pharmaceuticals, Inc.: Investigator, Research grant; Merck: Investigator, Research grant; Astellas pharma Europe B.V (APEB): Investigator, Research grant; Cubist pharmaceutical: Investigator, Research grant; Rempex Pharmaceuticals, Inc.: Investigator, Research grant; Tetraphase Pharmaceuticals: Investigator, Research grant; Multiple Industry Sponsors: Investigator, Research grant.

2214. Chronic Hepatitis C: Closing the Gap Towards Eradication—Screening Young Adults vs. Baby Boomers