Opt-in testing programme finds thousands with HIV, hepatitis B and C

A new report published by the UK Health Security Agency (UKHSA) and the University of Bristol has found that the NHS England (NHSE) emergency department opt-out testing programme for bloodborne viruses has helped to diagnose thousands of people with serious infections.


The report, commissioned by NHSE, evaluates the first 12 months of the NHSE funded emergency department opt-out testing programme for bloodborne viruses. The programme, introduced in April 2022, aims to test people attending emergency departments who are having a blood test, regardless of symptoms. The aim is to increase the number of people diagnosed and in treatment and care for HIV, hepatitis B and hepatitis C, in line with disease elimination goals.

Thousands of people in England are thought to be living with an undiagnosed bloodborne virus – HIV, hepatitis B or C – which can be effectively treated (and cleared in the case of hepatitis C). Treatment can reduce the risk of developing serious illness or complications (such as liver cirrhosis and cancer in the case of hepatitis B and C), suppress the virus and prevent infection being passed on (if HIV is undetectable, it is untransmittable). 

During the first year, 33 emergency departments conducted 857,117 HIV tests, 473,723 HCV tests, and 366,722 HBV tests – significantly increasing the number of bloodborne virus tests conducted in England each year. 

Data from NHSE indicates that nearly 2,000 people were newly diagnosed with a bloodborne virus:

  • 499 people with hepatitis C
  • 1,143 people with hepatitis B
  • 341 people with HIV

The testing is detecting infection in people who were otherwise unlikely to have been diagnosed without presentation to health services with specific complications, enabling them to access treatment. This access to treatment improves their longer-term health outcomes and saves lives.  

A detailed analysis of 5 of the 33 sites (all in London) revealed that 1.1% of tests were positive for hepatitis B, 0.9% of tests were positive for HIV and 0.2% were positive for hepatitis C.

Dr Sema Mandal, Deputy Director of Blood Safety, Hepatitis, STI and HIV division at UKHSA, said: “The opt-out testing programme in emergency departments is making a significant impact in diagnosing those living with HIV, hepatitis C and hepatitis B. Our 12-month evaluation highlights how many people are living with an undiagnosed bloodborne virus. Fewer new diagnoses of HIV and hepatitis C were made compared to hepatitis B, highlighting the significant efforts and financial investment made to enhance diagnosis and treatment for HIV and HCV. Similar efforts are necessary for HBV to meet disease elimination targets.”

The report highlights that integrated care boards (ICBs), NHSE and other commissioners, and service providers should consider the diverse needs of people diagnosed in emergency departments. This includes offering community support to facilitate linkage to care for people diagnosed through the programme. 

Recommendations to achieve equal access to testing include ensuring consistent high testing rates across all sites within the programme. Implementing standardised opt-out procedures in line with good practice, including automated testing procedures and knowing when to use verbal prompts and signposting to information is essential to achieve high testing rates. This will also ensure that between-site variations do not cause inequalities in offer and access to testing.

The full report can be accessed at https://www.gov.uk/government/publications/bloodborne-viruses-opt-out-testing-in-emergency-departments


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