The UK Health Security Agency (UKHSA) has published an evaluation of the NHS emergency department (ED) opt-out testing programme for bloodborne viruses (BBVs) — HIV, hepatitis B (HBV), and hepatitis C (HCV). The initiative, running in 34 EDs across high HIV-prevalence areas, automatically tests patients for BBVs as part of routine bloodwork unless they opt out.
Over its first 33 months (April 2022–January 2025), the programme carried out more than 7 million tests — around half of all BBV testing in participating regions — with a high uptake rate of about 70%. It identified 3,667 new HBV cases, 831 HCV cases, and 719 HIV cases.
Additionally, 291 people previously diagnosed with HIV were re-engaged in care. Overall, one in 240 people tested positive for HBV, one in 1,276 for HCV, and one in 1,916 for HIV.
More than 60% of participants had never been tested for BBVs before, demonstrating the programme’s reach among people not typically accessing other healthcare services. Uptake was particularly strong among older adults (72% in those aged 80+) and ethnic minority groups (68.8% Asian Other; 73.1% Black Caribbean).
Most newly diagnosed individuals (73%) had not previously been tested, and 80% had attended an ED in the previous year, showing that EDs are effective settings for such testing.
Notably, half of new HIV diagnoses were late-stage, compared to 36.9% in other healthcare environments, suggesting ED opt-out testing acts as a crucial safety net for early detection and life-saving treatment.
