The UK Health Security Agency has today published its evaluation
report of the groundbreaking NHS emergency department
(ED) opt-out testing
programme – an integrated bloodborne virus (BBV) testing programme for HIV, hepatitis B and
hepatitis C.
The evaluation findings show the programme has identified
thousands of people living unknowingly with bloodborne viruses,
with many now being offered life-saving treatment for the first
time.
As part of blood tests taken during emergency care in 34 EDs in
areas with the highest HIV prevalence, people
are automatically tested for HIV, hepatitis B, and
hepatitis C unless they opt out. Those who receive a diagnosis
are then offered treatment and support.
The results demonstrate the programme's significant impact. Over
33 months, it conducted over 7 million BBV tests, representing around 50% of
all BBV testing done in
these areas during this period. It achieved a high test uptake
rate of around 70% among eligible people, demonstrating the
effectiveness of the opt-out approach.
A large number of new diagnoses were identified:
• 3,667 new hepatitis B (HBV)
diagnoses
• 831 new hepatitis C (HCV)
diagnoses
• 719 new HIV
diagnoses
One in 240 people tested was found to have hepatitis B,
highlighting the large number of people who are living with
undiagnosed hepatitis B and the benefit of combined opt-out
testing for BBVs in EDs. Similarly, one in 1,276 people tested
was found to have with HCV and
one in 1916 for HIV. Further benefits
included care re-engagement including 291 people previously
diagnosed with HIV who were subsequently
re-linked to HIV care during the
programme.
The report, commissioned by NHS England, evaluates the first 33
months of the programme from April 2022 to 1 January 2025.
Dr Sema Mandal, Consultant Epidemiologist and Deputy Director of
the Blood Safety, Hepatitis, STI and HIV Division at
UKHSA,
said:
The pioneering NHS opt-out testing programme in emergency
departments is helping us reach thousands of people who did not
know they were living with HIV, hepatitis B or
hepatitis C. Many of these individuals might never have been
tested otherwise – missing the chance to access life-saving
treatment.
What we're seeing is a clear and urgent need to do more to tackle
these serious infections. The high number of new diagnoses across
all three conditions – particularly the consistently high
hepatitis B numbers – shows just how many people are living with
undiagnosed bloodborne viruses. We must improve awareness, expand
testing and diagnosis and ensure people are supported into care
and treatment. Early diagnosis can help prevent years of ill
health and save thousands of lives.
Public Health Minister said:
This groundbreaking programme continues to be a huge success,
identifying infections that would otherwise have gone
undiagnosed. By making testing a routine part of emergency care,
we're connecting patients with lifesaving treatment earlier and
helping to protect the wider community.
It has also found almost 300 people who were previously diagnosed
with HIV but
were not receiving any type of care when they took part in this
testing programme. I am delighted that because of this work, they
are now receiving the treatment they need.
It also helps us in our goal to end new HIV transmissions by 2030,
which depends on better access to testing and treatment. Every
new or untreated diagnosis we identify represents someone who can
now get the care they need.
Dr Claire Fuller, NHS England National Medical Director, said:
The rollout of blood-borne virus testing in NHS emergency
departments has been a gamechanger for the early detection of
HIV and viral
hepatitis – enabling thousands more people to get access to
life-saving treatments, which prevent long-term health issues and
reduce the chance of passing the viruses on to others.
This builds on testing already routinely available through GPs
and sexual health services across England and is a great example
of the NHS making every contact with patients count, helping
people to stay well, avoid illness and saving lives.
Over 60% of people tested had no record of previous BBV testing, indicating the programme
successfully reached populations who may not have been diagnosed
in other healthcare settings.
The programme delivered substantial benefits for older patients
and those from ethnic minority communities. BBV testing uptake reached 72% among
eligible people aged 80 years and older, with uptake rates of
68.8% among Asian Other and 73.1% among Black Caribbean ethnicity
ED attendees.
Around 73% of people newly diagnosed had not previously been
tested for a BBV and 80%
had attended an ED in
the year before the programme started, highlighting that this is
an effective location to carry out this testing.
Half of people newly diagnosed with HIV through the programme
had late-stage disease – substantially higher than in other
healthcare settings (36.9%). This suggests ED opt-out testing provided a
‘safety net' for finding people living with HIV who were not identified
in other health care services. It also reinforces the importance
of early detection for better individual outcomes.
