NHS A&E blood-testing finds 2,000 unidentified HIV cases in first four years

Nearly 2,000 people unknowingly living with HIV have been diagnosed by a pioneering NHS programme, which tests anyone needing a blood test in A&E, saving lives and preventing new infections, shows new data.

Under the first-of-its kind, large scale programme, adults in need of a blood test in A&E in 88 areas of England with the highest rates of HIV are routinely tested for the virus alongside hepatitis B and C unless they opt out.

Latest NHS data shows that 1,900 previously undiagnosed cases of HIV have now been identified by the programme since it began in April 2022.

If someone's test comes back positive for HIV (or hepatitis B or hepatitis C) the person is offered specialist support from the NHS, and a treatment plan is agreed with them.

Almost all (93%) individuals diagnosed by the programme had no record of a prior HIV test according to research by the UK Health Security Agency (UKHSA) which health chiefs believe shows the initiative is reaching people who are unlikely to be tested routinely through other routes.

The data comes as a major new economic evaluation study published in The Lancet HIV  estimates that the first 802 new diagnoses from the programme's initial phase, will prevent around 187 HIV-related deaths and 28 new transmissions over the next 20 years.

The research conducted by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Evaluation and Behavioural Science at University of Bristol found the programme is cost-effective and is enabling people to start life-saving treatment sooner, improving health outcomes and reducing onward transmission.

One person whose previously unidentified HIV was found by the NHS ED Opt-Out Testing Programme is Ayo from Manchester, who is in his 50s. From November 2022, Ayo experienced nerve pains throughout his body and numbness in his face. He was off work, unable to perform his job and his plans to go to university were put on hold.

Over time, Ayo's condition deteriorated further. He lost 20 kilograms in weight and the neuropathic pain continued. Eventually, very unwell with a high fever and an abscess on his neck, he was rushed to Manchester Royal Infirmary's Emergency Department.

It was there that Ayo was tested for HIV as part of the NHS Blood Borne Virus Opt-Out Testing Programme, and his test result came back positive.

Ayo, said: If I wasn't in hospital, I wouldn't have been tested for HIV. It wasn't something I thought would affect me in my fifties, but in the blink of an eye, everything changed.

Now I know my status, I can protect my wife and stay well for my family.

One in 20 people living with HIV in England don't know they have it, and many others are only diagnosed after the virus has already caused serious damage to their health.

Professor Francesca Swords, NHS national medical director, said: Knowing your HIV status is as important as checking your blood pressure; and this pioneering NHS programme is helping hundreds of people get a diagnosis often before they have any symptoms at all to access life-saving treatment.

The NHS is committed to improving early detection of HIV and other blood borne viruses, and by helping more people get a diagnosis, this initiative is helping reduce the chance of people unknowingly passing it on to others.

The rollout of this testing in A&Es is an excellent example of how the NHS is making every contact with patients count to support them to stay well and access treatment they may need, helping to save lives while making the best use of our resources.

The HIV Action Plan 2025-2030, published by DHSC in collaboration with UKHSA and NHS England, sets out the government's approach to end new HIV transmissions within England by 2030. It will continue the success of the blood-borne virus ED opt-out testing programme, investing £156 million from April 2026 to March 2029 to deliver opt-out HIV, Hepatitis B and Hepatitis C testing in emergency departments in very high and high HIV prevalence areas.

Dr Josephine Walker, lead author at the University of Bristol & NIHR Health Protection Research Unit in Evaluation and Behavioural Science, said: At around £6 per HIV test, and even though a large number of tests are required to identify one undiagnosed person living with HIV, the programme is good value for money for the NHS. Importantly it has led to linkage to treatment to improve the health and lifespan of many people who were previously living with undiagnosed HIV.

The study researchers say their findings provide evidence to support the continuation of opt-out testing in emergency departments as part of DHSC's HIV action plan- which aims to end new HIV transmissions in England by 2030.

Professor Marian Knight, Scientific Director for NIHR Infrastructure, said: "To end HIV transmission, we have to make it as straightforward as possible for people to be tested wherever easiest for them. This ED testing scheme is doing exactly that - finding hundreds of unidentified HIV cases among people who may never have otherwise sought a test.

Research supported by two of our NIHR Health Protection Research Units shows that this is a highly cost-effective intervention. This marks a critical pivot from sickness to prevention, protecting communities who need it the most."

NHS leaders are continuing to rollout the programme to help more people unknowingly living with HIV; and a further three new hospitals will start offering testing to their ED patients by April 2027.

Dr Tamara Djuretic, Consultant Epidemiologist and Head of HIV Section at UKHSA, said: NHS opt-out testing in emergency departments is helping to reach people who don't realise they're living with HIV or other blood-borne viruses. Many of these people might not have been tested otherwise.

This new research underscores the programme's long-term value - earlier detection of HIV not only improves individual health outcomes and saves lives but also supports wider public health HIV prevention efforts.

The three additional EDs taking part in the programme means it will be available in nearly all areas of England.

Katie Clark, Head of Policy at Terrence Higgins Trust, said: This routine approach to HIV testing in emergency departments has been game changing. We now have very clear evidence that not only does this front-footed approach mean we are diagnosing people who are unlikely to be tested anywhere else, but also that it's excellent value for money. The continuation of opt-out HIV testing is crucial as we work to end new HIV cases in England by 2030 and ensure no one regardless of gender, ethnicity or location is left behind. The next step is to take the same approach to GPs in areas with a very high HIV prevalence."

For more information on HIV testing services, visit nhs.uk website.