A new report published today by the UK Health Security Agency (UKHSA) and the University of Bristol has found that the NHSE Emergency Department Opt-Out testing Programme for bloodborne viruses has helped to diagnose thousands of people with serious infections.
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).
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.
Rachel Halford, Chief Executive at The Hepatitis C Trust, said:
“The pilot scheme for opt-out testing for blood-borne viruses at emergency departments has proven to be a successful way to find people who would otherwise not know that they were living with HIV, hepatitis B or hepatitis C. There are many people, including those experiencing homelessness, that only interact with healthcare services via emergency departments and the scheme is a great way to reach and treat these people.
“This life-saving initiative must now be expanded across the whole of the UK to ensure that everyone who is living with a blood-borne virus is found and offered treatment. 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.”
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 undiagnosed blood borne 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 elimination targets.”
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.”