New evaluation of NHS England's emergency department opt-out testing has identified thousands of people living unknowingly with bloodborne viruses.
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 Ashley Dalton 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.
