More evidence of the importance of opt-out hepatitis B and C testing

Posted on: 29th November 2024

A new report launched today provides yet more evidence for The British Liver Trust’s call for routine, opt-out hepatitis B and hepatitis C testing.

The report shares the latest findings from the Emergency department bloodborne virus opt-out testing programme. In total 1,957 people were found to have hepatitis B. This builds on previous findings from the programme. These showed far more people are living with Hepatitis B than was previously thought.

The new report was published by the UK health security agency (UKHSA). It covers data collected over 2 years at 21 emergency departments across the UK.

Pamela Healy OBE, Chief Executive at the British Liver Trust said:

This latest report shows that there are far more people in the UK with hepatitis B than previously thought. It also provides clear evidence for the importance of rapidly rolling out testing to every emergency department in the UK. The Trust is also calling for improved treatment pathways for hepatitis B so that everyone who is diagnosed through the opt-out testing is treated in a timely manner in their local community.

Key findings:

In the first 24 months, 34 emergency departments conducted 1,981,590 HIV tests, 1,502,799 hepatitis C tests, and 1,185,678 hepatitis B tests, significantly increasing the annual number of bloodborne virus tests in England.
Among those tested, 73% had no record of a previous HIV test, 80% had not been tested for hepatitis C, and 76% had no record of a hepatitis B test in surveillance data. These figures suggest the programme is successful in reaching people who have not previously tested for these three bloodborne viruses.
The analysis looked in depth at 21 of the 34 sites, between April 2022 and March 2024. It found that:
- 1,957 people were newly diagnosed with hepatitis B
- 762 people were newly diagnosed with hepatitis C
- 391 people with HIV (new HIV diagnoses data is only available to December 2023)

What is opt-out testing?

Many people have viral hepatitis for years before they get symptoms. Most will never have heard of hepatitis B. Or may not be aware that they could be at risk. So they are unlikely to come forward and ask for a test.

But most of us will, at some point, need to visit a hospital emergency department. These visits often involve blood tests. The blood borne virus test is also a blood test and can be done at the same time. So opt-out testing makes use of these visits, by offering a test for hepatitis B, hepatitis C and HIV to everyone having a blood test in an emergency department.

Importantly the test is offered to everyone over the age of 18. It does not matter about your ethnicity, health, or if you think you may be at risk or not. People can opt-out if they do not want the test. But the programme found that most of those eligible took part.

Why is finding viral hepatitis important?

Hepatitis B and C are liver conditions caused by hepatitis viruses. People can live with viral hepatitis for decades. But without treatment the virus can eventually lead to serious medical problems. Including cirrhosis and liver cancer.

There is now a very safe and effective treatment for hepatitis C. With well established pathways for care. So finding the condition early means that serious complications can be prevented.

There are additional challenges for those with hepatitis B. For a long-time hepatitis B was considered very rare in the UK. This meant people were not being tested for it. The new report found that almost 8 in 10 people having the opt-out test had never been tested for hepatitis B before. There is currently no national treatment and care surveillance scheme for hepatitis B.

This means some NHS services were unprepared for the large number of people diagnosed through opt-out testing. This is likely to get worse if those who have not been found yet are not tested until they are already very unwell.

The World Health Organisation (WHO) has set the goal of eliminating viral hepatitis as a public health threat by 2030. In the UK, opt-out testing is a vital part of this.

Researchers compared data from the programme to that from the normal routes of diagnosis. They found that the proportion of people diagnosed who were of black African ethnicity was much higher in the opt-out testing. Opt-out testing also found a higher proportion of people who were aged over 50 or who lived in a deprived area.

This suggests that lots of people in these groups who have hepatitis B or C are not being diagnosed. They are missing out on vital help, treatment and monitoring that could prevent serious illness or even death. Those closest to someone with hepatitis B are also missing out on a vaccine that could prevent them picking up the virus.

The British Liver Trust has been calling for opt-out testing to be routine since this programme was launched in 2022.

The programme will continue in selected emergency departments across the UK until spring 2025.