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HIV and Hepatitis Testing Identified Thousands of New Cases

The first year of a £20 million 3-year programme to roll out opt out HIV testing in emergency departments in the areas in England of highest diagnosed HIV prevalence identified almost 2000 people with HIV or hepatitis who were previously undiagnosed, according to NHS England.

Under the pilot scheme, people presenting to A&E and having blood tests as part of their visit had an extra aliquot taken for HIV, and often also for hepatitis B (HBV) and hepatitis C (HCV) screening. Many EDs started with testing for HIV, then progressed to testing for hepatitis B and C as well. 

Patients are informed that their sample will be tested for blood born viruses, including the option to opt out and how to do so, but pre-test counseling or explicit consent are not required.

If a test comes back positive for HIV, HBV, or HBC, the patient is offered specialist support from HIV, sexual health, and hepatitis services, which take responsibility for patient notification and linkage to care. 

The opt-out testing initiative was started in April 2022 as part of the Government’s HIV Action Plan launched in 2021 and will run until 2025. The pilot involved 33 hospital emergency departments in high HIV-prevalence areas, including London, Brighton, Manchester, Salford, and Blackpool. By the end of year one, the number of sites testing for HIV was 33, for HBV was 25, and for HCV was 29. 

Overall testing uptake as a proportion of ED attendees having blood tests was 64% for HIV (range of 6% to 96%), 37% for HBV, and 48% for HCV. The first year of the programme detected:

  • 343 people with HIV
  • 1186 people with HBV
  • 465 people with HCV
In addition, it identified many people previously diagnosed but not known to be receiving care, including:
  • 209 people with HIV
  • 156 people with HBV
  • 108 people with HCV

'Staggering' Results of Initial Pilot

Opt-out HIV testing was first piloted in emergency departments in South London by the Elton John AIDS Foundation. Anne Aslett, its chief executive, described the results as "staggering", and said they had paved the way for opt out HIV testing to go country wide.

She said: "Since opt-out testing in the highest prevalence areas began last April, the system has diagnosed people from the ages of 18 to 85. It has been incredible to see how opt-out testing has changed the lives of people living with HIV."

NHS National Medical Director Professor Sir Stephen Powis said: "Effective testing for blood-borne viruses is vital in helping us identify and treat more people living with HIV and hepatitis, so we are very pleased with the positive impact of our routine opt out testing programme.

"Increasing the early detection and diagnoses of HIV, hepatitis and other blood borne viruses enables us to provide people with better access to the latest and most effective life-saving medication, which can prevent long-term health issues and reduces the chance of unknown transmissions to others."

On Track to End New HIV Transmissions by 2030

Richard Angell, chief executive at the Terrence Higgins Trust, said: "The expansion of A&E HIV and hepatitis testing is essential to reaching our life-changing goal of ending new HIV cases by 2030. The results from 1 year of opt-out testing in areas with very high HIV prevalence are above and beyond what anyone expected and have demonstrated an incredible return on investment."

In addition to reporting the success of the opt out testing programme, the 

Government also published an update to its HIV Action Plan for England. It announced that England was "on track to end new HIV transmissions by 2030". New HIV transmissions in England had fallen by almost a third between 2019, when the ambition was set, and 2021, it said, and the plan also on track to reduce new HIV transmissions by 80% by 2025.

"Fewer people remain unaware of their HIV status as a result of increased testing across the country," according to a joint announcement by the UK Health Security Agency, NHS England, and Department of Health and Social Care. In parallel, AIDS cases had fallen by almost one-fifth.

"Reducing undiagnosed HIV infection through testing not only provides access to treatment that saves lives, but also means people who obtain undetectable levels of the virus cannot pass on HIV," the report said.

The Action Plan included £3.5 million to deliver a national HIV prevention programme between 2021 and 2024.

During the last year, the NHS has also struck a series of deals for the latest HIV drugs, while NHS England launched an online service through which people can order self-testing kits for HCV.