Stuart Smith, Vanessa Hebditch, Richard Angell and Deborah Gold holding signs saying 'Expand hepatitis testing in A&Es' and 'Expand HIV testing in A&Es' outside Downing Street.

NHS England has released the results from the first year of opt-out HIV and hepatitis testing in hospitals in areas with a very high HIV prevalence. The data shows the programme's success is surpassing all expectations and exposing the postcode lottery in hospital testing. 

The Government must now fund opt-out HIV testing for the next tranche of A&E departments – high prevalence areas – as the Government’s own guidance recommends. This is the conclusion of five leading HIV and hepatitis charities.

In just 12 months, more than 1,998 people have been found with HIV, hepatitis B and hepatitis C as a result of opt-out testing. The initiative also found an additional 470 people who were previously diagnosed, but were not receiving life-changing treatment. 

This pioneering approach to testing has saved the NHS millions in care costs because those diagnosed have been able to initiate treatment. Once diagnosed and on effective medication, a person living with HIV can live a long, healthy life and can’t pass on the virus. Hepatitis C can be cleared with medication and treatment can prevent hepatitis B from causing permanent liver damage. 

Funding for opt-out testing in the very highest prevalence areas – London, Brighton, Manchester and Blackpool – was allocated as part of the Government’s HIV Action Plan in 2021. In February, as a result of campaigning from MPs and council leaders across the country, Public Health Minister Neil O’Brien committed to consider funding for expanding opt-out HIV testing to the next 32 areas and 42 A&Es with a high HIV prevalence. It’s estimated that a further £18 million is needed to implement this for one year. 

Scaling up this testing programme is a 'no brainer', according to Terrence Higgins Trust, National AIDS Trust, the Elton John AIDS Foundation, Hepatitis C Trust and the British Liver Trust, who say it’s fundamental to get the country on track to end new cases of HIV and meet ambitious targets on hepatitis.

Opt-out HIV testing in A&E departments is effective in diagnosing more women, heterosexuals and those of Black ethnicity who may never go to a sexual health clinic. This shows the clear role opt-out HIV testing will play in tackling health inequalities and driving us all – regardless of gender, ethnicity, age or sexuality – towards ending new HIV cases by 2030.
Richard Angell, Chief Executive at Terrence Higgins Trust, said: 'The expansion of A&E HIV and hepatitis testing is essential to reaching our life-changing goal of ending new HIV cases by 2030. The results from one year of opt-out testing in areas with very high HIV prevalence are above and beyond what anyone expected and have demonstrated an incredible return on investment. In fact, the NHS data shows that if there had been funding in all hospitals where the Government’s own guidance recommends opt-out testing takes place, an additional 500 people would be newly diagnosed with HIV or returned to care. 

'Every day that passes, we miss opportunities to find more people with HIV, hepatitis B and hepatitis C across England and ensure they are accessing the care they need. Some will be developing serious illness. They cannot afford for there to be further delay – the Government must fund opt-out HIV testing for high prevalence areas now.'
Anne Aslett, Chief Executive at Elton John AIDS Foundation, said: 'When the Elton John AIDS Foundation first piloted opt-out HIV testing in emergency departments in south London, the results were not only staggering, they also paved the way for opt-out HIV testing to go country wide. Since opt-out testing in the highest prevalence areas began last April, the system has diagnosed people from the ages of 18 to 85.

'It has been incredible to see how opt-out testing has changed the lives of people living with HIV. No more delays – we need to ensure that opt-out HIV and hepatitis testing is standard practice in this country.'
Deborah Gold, Chief Executive at National AIDS Trust, said: 'Twelve months on from the roll out of opt-out HIV and hepatitis testing in hospitals in London, Blackpool, Brighton and Manchester and the evidence is clear – it is working.

'This vital initiative is needed to diagnose the 4,400 people living with undiagnosed HIV across England. The programme is also finding people living with HIV from groups who are less likely to test anywhere else, including women, heterosexuals and those of Black ethnicities. Now they can receive the care they need and can expect improved health outcomes, while preventing the onward transmission of the virus. It’s also saving the NHS money through getting people onto treatment and reducing hospital admissions. 

'Any further delay from the Government on expanding opt-out testing would mean missing the chance to diagnose hundreds of people – from Birmingham to Portsmouth, and Derby to Peterborough. We need to see this approach rolled out in all high prevalence areas to make sure every person has an equal chance of being diagnosed and accessing treatment.'

Rachel Halford, Chief Executive at Hepatitis C Trust, said: 'The opt-out hepatitis testing has shown incredible results in its first year, identifying many people who would otherwise not know that they were living with the virus. If left untreated, hepatitis C can be fatal; it is a race against time to find those who remain undiagnosed.

'We’re urging the Government to expand this initiative to save the lives of many more people who are unaware that they’re living with hepatitis and to ensure we meet the government’s target of eliminating hepatitis C by 2025.'
Pamela Healy, Chief Executive at the British Liver Trust, said: 'The first-year data on opt-out testing for hepatitis B and C is clear evidence of its potentially life-saving impact in England. Thousands of individuals live with undiagnosed hepatitis B and C, unaware of their infection as there often no symptoms in the early stages. If untreated, these viruses can cause liver damage and increase the risk of liver cancer. Finding these individuals through opt-out testing is crucial for their treatment and preventing further transmission. 
'NHS data on opt-out testing has revealed a postcode lottery of hepatitis diagnoses, with over 1,000 cases identified in just four cities. Nationwide implementation of opt-out testing could uncover many more cases, saving lives and reducing transmission.'