Hundreds of people in England have benefited from an earlier diagnosis of HIV, hepatitis B, and hepatitis C as a result of an opt-out testing programme for bloodborne viruses, a study found.
NHS England introduced the programme in April 2022 to test patients having a blood test in emergency departments regardless of whether they had any relevant symptoms. Areas selected for the programme had very high rates of HIV prevalence, and the aim was to increase the number of people diagnosed and treated in order to help reach disease elimination goals.
Interim Report
NHS England commissioned researchers at the University of Bristol to evaluate the programme's performance in its first 12 months of operation. The interim report, published by the UK Health Security Agency (UKHSA) on 9 November, found that during the first year, 33 emergency departments conducted 857,117 HIV tests, 473,723 tests for hepatitis C, and 366,722 tests for hepatitis B.
The figures represented a significant increase in the number of bloodborne virus tests conducted in England each year, according to the Agency.
Data from NHS England indicated that nearly 2000 people were newly diagnosed with a bloodborne virus. The figure included 1143 people with hepatitis B, 499 with hepatitis C, and 341 with HIV.
The researchers used linked datasets to examine the characteristics and numbers of people newly and previously diagnosed at 16 of the 33 sites. A detailed analysis of five of the sites—all in London—found that 1.1% of the tests were positive for hepatitis B, 0.9% were positive for HIV, and 0.2% were positive for hepatitis C.
Across all sites, the population eligible to be tested tended to be older than the population tested for bloodborne viruses in other settings. The ethnic distribution of eligible attendees varied by geography and reflected local population demographics, explained the UKHSA.
The data showed that:
- Men had higher new diagnoses for all three bloodborne viruses.
- People aged 35-64 years had the highest number of new diagnoses for HIV and hepatitis B.
- People aged 50-80 years had the highest number of new hepatitis C diagnoses.
- People of Black African ethnicity had the highest proportion of new diagnoses for HIV and hepatitis B.
- People of White 'other' (ie, non-British) ethnicities had the highest proportion of new diagnoses for hepatitis C.
Testing uptake varied considerably between the five 'deep dive' sites and ranged from 22% to 74%. There was little difference in test uptake in relation to ethnicity, sex, and age group within sites.
"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," according to the UKHSA.
Dr Sema Mandal, deputy director of the blood safety, hepatitis, STI, and HIV division at the Agency, said: "Fewer new diagnoses of HIV and hepatitis C were made compared with 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."
To ensure equal access to testing, the report recommends the NHS maintain consistent high testing rates across all sites.
Programme "Should Be Extended Nationwide"
Commenting on the report's findings, Pamela Healy, chief executive of the British Liver Trust, said the programme "needs to be extended nationwide to not only save lives but also ease the strain on NHS resources".
Rachel Halford, chief executive of the Hepatitis C Trust, noted that many people only interacted with healthcare services via emergency departments. "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," she said.
Richard Angell, chief executive of the Terrence Higgins Trust, said the report demonstrated that opt-out testing tackles inequalities, is cost-effective, and is "highly impactful in finding those living with undiagnosed HIV".
