A new report published by the UK Health Security Agency (UKHSA) and the University of Bristol has found that the NHSE Emergency Opt-Out testing Programme for bloodborne viruses has helped to diagnose thousands of people with serious infections.
The report, commissioned by NHS England (NHSE), evaluates the first 12 months of the NHSE funded Emergency Department (ED) Opt-Out testing programme for bloodborne viruses (BBV). 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 blood-borne 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).
“This report shows HIV opt-out testing is a triumph – its contents make clear opt-out HIV testing is cost-effective, tackles inequalities and highly impactful in finding those living with undiagnosed HIV.”
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 BBV tests conducted in England each year.
Data from NHSE indicates that nearly 2,000 people were newly diagnosed with a bloodborne virus – 499 with hepatitis C, 1143 with hepatitis B and 341 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 five 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. The data shows that men had higher new diagnoses for all three BBVs and people aged 35 to 64 had higher new diagnoses for HIV and hepatitis B, while ages 50 to 80 had higher new hepatitis C diagnoses than other age groups. For HIV and hepatitis B, the highest proportion of new diagnoses were among people of black African ethnicity, and for hepatitis C, it was among people of white ethnicities other than white British.
Although the highest proportion of new diagnoses was for hepatitis B; pathways into care are more established for HIV and hepatitis C. According to UKHSA, improvements and increased capacity for care pathways for hepatitis B are “needed to ensure that the needs of those newly diagnosed through the programme are met”.
Commenting on the report, Richard Angell, Chief Executive of sexual health charity Terrence Higgins Trust, said: “This report shows HIV opt-out testing is a triumph – its contents make clear opt-out HIV testing is cost-effective, tackles inequalities and highly impactful in finding those living with undiagnosed HIV. In just four cities, this innovation has almost doubled the number of HIV tests carried out in England and is successfully changing people’s lives for the better.
“This life-saving initiative must now be expanded across the whole of the UK to ensure that everyone who is living with a blood-borne virus is found and offered treatment.”
“Hundreds of people now know their status and are on a pathway to life changing treatment – very many of whom would be unlikely to access HIV testing via any other route or when it was too late. Even more have been diagnosed with hepatitis B and hepatitis C, showing the power of combining bloodborne virus testing, which is more efficient, saves money and destigmatises testing. With the publication of today’s report, it’s now time to urgently expand opt-out to more A&Es in England to change even more lives and ensure we make the rapid progress necessary to end new HIV cases by 2030.”
Rachel Halford, Chief Executive at the Hepatitis C Trust, added: “The pilot scheme for opt-out testing for blood-borne viruses at emergency departments has proven to be a successful way to find people who would otherwise not know that they were living with HIV, hepatitis B or hepatitis C. There are many people, including those experiencing homelessness, that only interact with healthcare services via emergency departments and the scheme is a great way to reach and treat these people.
“This life-saving initiative must now be expanded across the whole of the UK to ensure that everyone who is living with a blood-borne virus is found and offered treatment. Rolling out the scheme would save more lives and help ensure we meet the government’s target of eliminating hepatitis C in England by 2025.”
Anne Aslett, CEO of Elton John AIDS Foundation, said: “The Elton John AIDS Foundation launched the first HIV Social Impact Bond in 2018 because of a stagnation in the number of new HIV diagnoses in the UK and too many vulnerable people were being left behind. We identified opt-out testing as an effective, and cost-saving, method to ensure people living with HIV got the treatment they needed. Between 2018 and 2021, more than 265,000 people were tested and over 460 south Londoners entered treatment.
“This report is further evidence of just how effective opt-out testing for bloodborne viruses in emergency departments is.”
“The results of another 341 people diagnosed with HIV and 208 re-engaged in HIV care between March 2022 and 2023 continues to show that opt-out HIV testing works to diagnose HIV and find those who have dropped out of care due to stigma and other challenges facing treatment, particularly for black African ethnicities. However, there are still an undiagnosed 4400 people living with HIV in this country. We need to ensure that we reach all communities across the country and roll out this successful method of HIV diagnosis to other high prevalence areas if we are to meet our target of ending new HIV transmission by 2030.”
Daniel Fluskey, Director of Policy at National AIDS Trust, said: “This report is further evidence of just how effective opt-out testing for bloodborne viruses in emergency departments is. Making testing routine in all emergency departments in HIV high prevalence areas, and beyond, is critical in helping us to reach our goal of ending new HIV transmissions by 2030.
“Because of this programme, there are now at least 340 people who now know they are living with HIV and can access transformative treatment, protecting their own health and stopping HIV from being passed on to others. Taking the vital learnings from the evidence will ensure the number of people diagnosed is even higher.”
To see the report, CLICK HERE
