Thousands diagnosed with HIV, hepatitis B and C following programme
An emergency department opt-out testing programme for bloodborne viruses has helped to diagnose thousands of people with serious infections
A new report published today 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.
The data shows that men had higher new diagnoses for all 3 bloodborne viruses and people aged 35 to 64 years had higher new diagnoses for HIV and hepatitis B, while people aged 50 to 80 years 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. 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.
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."
Matt Fagg, director for prevention and long-term conditions at NHSE, said:
"It is thanks to our routine opt-out testing programme in emergency departments that the NHS has been able to identify and treat thousands more people living with HIV and hepatitis.
"Without this testing programme, these people may have gone undiagnosed for years, but they now have access to the latest and most effective life-saving medication – helping to prevent long-term health issues and reducing the chances of unknown transmissions to others.
"The NHS is committed to making all contact with patients count, and this testing programme is a good example of how we are taking advantage of every opportunity to support people with staying well, preventing illness and saving lives."
Public Health Minister Neil O’Brien said:
"These are hugely positive results. By identifying new cases of bloodborne viruses, including HIV, we are making a real difference to people’s lives by supporting them to get into treatment. This amazing programme has already newly diagnosed nearly 2,000 people with a bloodborne virus.
"I am grateful to NHSE for its excellent work delivering this innovative intervention and to the work led by UKHSA in evaluating the programme – keeping us on track to end all new transmissions of HIV as part of our HIV Action Plan."
Professor Kevin Fenton, Chief Advisor on HIV to Government and Chair of the HIV Action Plan Implementation Steering Group, said:
"Since 2019, when the government first made its commitment to end new HIV transmissions, we have made significant improvements in reducing the numbers of new HIV infections through our HIV Action Plan.
"The opt-out testing programme is a flagship initiative, and these results show the effectiveness of that programme in identifying people living with undiagnosed HIV, who can then be signposted to support and treatment.
"While we know there are improvements to be made, this data gives us confidence that this essential part of our strategy is working. It’s crucial that we continue scaling up HIV testing so people receive high quality care as we work towards ending HIV transmission in England by 2030."
Pamela Healy, Chief Executive of the British Liver Trust said,
"Hepatitis B is often a silent virus and thousands of people in the UK are unaware they are infected with it. If left undetected, the virus can lead to liver damage and increase someone’s risk of developing liver cancer. It is crucial to find and provide treatment to these people to stop the virus causing further health issues and transmission. Testing people in emergency departments has proven highly effective and needs to be extended nationwide to not only save lives but also ease the strain on NHS resources."
Rachel Halford, Chief Executive at The Hepatitis C Trust, said:
"The pilot scheme for opt-out testing for bloodborne 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 bloodborne 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."
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."
Anne Aslett, CEO 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.
"Today’s 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 4,400 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."
Richard Angell, Chief Executive of Terrence Higgins Trust, said:
"Today’s 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 4 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.
"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."
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.