Emergency Department Opt-Out Testing: Thousands tested and diagnosed with HIV, hepatitis B and hepatitis C

Posted on: 9th November 2023

A new report published today by the UK Health Security Agency (UKHSA) and the University of Bristol has found that the NHSE Emergency Opt-Out testing Programme for bloodborne viruses has helped to diagnose thousands of people with serious infections. Nearly two thousand people with HIV, hepatitis C and hepatitis B have been newly diagnosed and can benefit from treatment to prevent serious illness and spread of infection. The programme found much higher numbers of previously undiagnosed cases of hepatitis B than HIV and hepatitis C indicating that there may be many more people living with undiagnosed hepatitis B than has previously been thought.

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 department has proven highly effective and needs to be extended nationwide to not only save lives but also ease the strain on NHS resources. The programme has also been successful in finding those with hepatitis C. There are many people, that only interact with healthcare services via emergency departments and the scheme is a great way to reach and treat these people. ”

The report, commissioned by NHS England (NHSE), evaluates the first 12 months of the NHSE funded Emergency Department (ED) Opt-Out testing programme for bloodborne viruses (BBV). 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 blood-borne 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).

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.”

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 BBV tests conducted in England each year.

Data from NHSE indicates that nearly 2,000 people were newly diagnosed with a bloodborne virus - 499 with hepatitis C, 1143 with hepatitis B and 341 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 five 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 BBVs and people aged 35 to 64 had higher new diagnoses for HIV and HBV, while ages 50 to 80 had higher new HCV diagnoses than other age groups. For HIV and HBV, the highest proportion of new diagnoses were among people of black African ethnicity, and for HCV, it was among people of white ethnicities other than white British.

Although the highest proportion of new diagnoses was for HBV; pathways into care are more established for HIV and HCV. Improvements and increased capacity for care pathways for HBV are needed to ensure that the needs of those newly diagnosed with HBV through the programme are met.

Matt Fagg, director for prevention and long-term conditions at NHS England, 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.”

You can find out more and read the full evaluation report here (link Bloodborne viruses: opt-out testing in emergency departments - GOV.UK (www.gov.uk) )