A new report published today by the UK Health Security Agency (UKHSA) has found that the NHS England emergency department opt-out testing programme for bloodborne viruses has helped to diagnose thousands of people with HIV, Hepatitis B and C.
The report, commissioned by NHS England, evaluates the first 24 months of the programme, which was introduced in April 2022. The programme involves testing people who are having blood tests in emergency departments, regardless of their symptoms, to identify, care and treat HIV, hepatitis B, and hepatitis C. The programme has been rolled out across 34 emergency departments (EDs) in areas that are known to have high rates of blood borne virus infections.
Many people in England are believed to be living with undiagnosed HIV, hepatitis B, or C. These infections can be effectively treated, and cured in the case of hepatitis C, reducing the risk of serious complications, suppressing the virus and preventing infection being passed on. If HIV is undetectable, it is untransmittable.
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 show the programme is successful in reaching people who have not previously tested for these three bloodborne viruses.
The UKHSA 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 Dec 2023)
The highest number of new diagnoses was for hepatitis B, which reflects a greater prevalence of undiagnosed hepatitis B compared to hepatitis C and HIV.
65% of people newly diagnosed with hepatitis C had no record to indicate common risk factors, such as homelessness, a history of incarceration, or injecting drugs. This suggests that the programme is diagnosing people who may not be identified as at risk and so may not seek or be offered a test in other settings.
While 93% of newly diagnosed people with HIV have been linked to care, fewer were recorded on a treatment pathway for hepatitis C.
No comparable linkage to care data was available for hepatitis B, but there was an increase in people newly diagnosed attending a liver clinic in the second year of the programme. Improvements and increased capacity for care pathways for hepatitis B are needed to ensure that the needs of those diagnosed through the programme are met.
Dr Sema Mandal, Consultant Epidemiologist and Deputy Director 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 evaluation indicates that many people are unaware they have a bloodborne virus infection. This programme is identifying infections in people who might not seek testing otherwise, enabling them to access treatment earlier.
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 hepatitis C. Similar focus for hepatitis B is now needed to meet disease elimination targets.
Today’s report comes as the UKHSA also publishes its third HIV Action Plan monitoring and evaluation framework (MEF) which focuses on the interim ambitions of England’s HIV Action Plan 2022 to 2025.The MEF report found that, while there has been positive progress made towards hitting these targets, including increases in testing and uptake of PrEP, and an increase in the number of people with an undetectable viral load – the ambitions of the HIV Action Plan 2022 to 2025 are unlikely to be met.
The MEF report calls for a concerted effort to reduce sexual health inequalities which is prompting this stalling progress – with cases of HIV increasing among ethnic minority groups. Addressing these widening inequalities, ramping up testing, improving access to PrEP and getting people started on HIV treatment earlier will all be crucial to achieving to ambitions of the HIV Action Plan 2022 to 2025.
