The UK Health Security Agency (UKHSA) has released an evaluation report on the NHS emergency department (ED) opt-out testing programme for bloodborne viruses (BBVs), including HIV, hepatitis B, and hepatitis C. The findings show that thousands of people living unknowingly with these infections have now been diagnosed and offered life-saving treatment for the first time. The initiative automatically tests patients for BBVs during routine blood tests in 34 emergency departments across areas with the highest HIV prevalence unless they choose to opt out.
Over a 33-month period, the programme carried out more than seven million BBV tests, accounting for about half of all such testing conducted in the target areas. It achieved an impressive 70% test uptake rate among eligible patients, underscoring the effectiveness of the opt-out approach. The testing identified 3,667 new hepatitis B cases, 831 new hepatitis C cases, and 719 new HIV cases. Additionally, 291 individuals previously diagnosed with HIV but not in care were reconnected with treatment services. These findings highlight a large population of undiagnosed individuals and the success of ED-based testing in reaching them.
Experts have praised the initiative’s success and called for further expansion. Dr. Sema Mandal of UKHSA emphasized the urgent need to improve awareness, testing, and linkage to care, noting that early diagnosis prevents severe illness and saves lives. Public Health Minister Ashley Dalton described the programme as a major success in identifying infections that would otherwise remain hidden, helping the UK move closer to its goal of ending new HIV transmissions by 2030.
NHS England’s National Medical Director, Dr. Claire Fuller, noted that the rollout has been a “gamechanger” for early detection, allowing thousands to access treatments that reduce long-term complications and transmission risks. The evaluation also found that over 60% of those tested had no record of previous BBV testing, demonstrating the programme’s effectiveness in reaching underserved groups. Uptake was especially high among older adults and ethnic minority communities, with significant participation among people aged 80 and above, as well as among Asian Other and Black Caribbean patients.
Furthermore, around 73% of people newly diagnosed had never been tested before, and 80% had previously visited an emergency department, confirming that EDs are crucial venues for identifying undiagnosed cases. Notably, half of those newly diagnosed with HIV were at a late stage of infection, highlighting the role of ED opt-out testing as a vital safety net for detecting and treating serious infections earlier.
