Expanding HIV testing to A&Es

On World AIDS Day 2021, as part of the HIV Action Plan for England, the Government announced a £20 million investment in opt-out HIV testing in A&Es in areas with the ‘highest’ HIV prevalence.

Our friends at the Elton John AIDS Foundation (EJAF) had trailed this approach in hospitals in South London, whereby anyone who has their blood taken in A&E is tested for HIV unless there opt-out.

Based on their findings, the HIV Commission (founded by Terrence Higgins Trust, EJAF and National AIDS Trust) made expanding opt-out HIV testing one of its flagship recommendations. Our supporters and partners from across the HIV sector were key to putting the case to the UK Government and making this happen.

In April 2022, HIV testing in A&Es was rolled out in hospitals in all areas in England classed by UK Health Security Agency (UKHSA) as having a ‘very high’ prevalence of HIV: in London, Brighton and Manchester. Local MPs and council leaders in Blackpool successfully lobbied for Blackpool to also be funded.

As a result of additional funding from the Hepatitis C Elimination Programme, hepatitis B and hepatitis C testing was included and all of London – including areas considered ‘high’ and ‘low’ prevalence – benefitted.

Making blood-borne virus testing routine in A&Es has been incredibly successful. More than 2,000 people have been newly diagnosed with HIV, hepatitis B and hepatitis C in the first year of the scheme, saving lives and saving the NHS millions in care costs, by finding people and making sure they get the treatment and care they need. Even the Health Secretary has praised the approach because testing and finding people early is better for patients and cheaper for the NHS.

Opt-out testing also addresses health inequalities, finding people most likely to be diagnosed late by other services. EJAF’s pilot showed that A&E testing is more likely to find people of Black African ethnicity, women and older people – all groups who are less likely to be offered an HIV test in a sexual health service.

In England, we're calling for the UK Government to fund opt-out HIV testing in all areas UKHSA classes as having a ‘high’ prevalence of HIV, in line with NICE’s national guidelines. To find the 4,400 people with undiagnosed HIV in England, we have to make testing routine across the country, from Bury to Birmingham and Portsmouth to Peterborough.

We know this will work because there have been diagnoses in all of the A&Es in London with a high prevalence. More than 2,000 supporters signed our open letter to Public Health Minister Neil O’Brien and NHS England Chief Executive Amanda Pritchard calling for this.

In Scotland, the potential benefit that opt-out testing in A&Es is clear. We want the Scottish Government to commit to piloting of opt-out HIV and BBV testing in A&Es in areas of highest HIV prevalence.

In February 2023, Peter Gibson MP asked if the Government could expand testing at Prime Minister's Questions. In March. leader of the House of Commons Penny Mourdant highlighted the success of opt-out testing, saying ‘this is something we should be doing everywhere.’

Nicola Richards MP led a debate in parliament in July 2023, during which she laid out the case for funding for opt-out expansion. Nicola pressed the issue again at Prime Ministers Questions in September. Mayor of the West Midlands Andy Street and Mayor of Bristol Marvin Rees have both called for expansion to their areas.

Previous Public Health Ministers Steve Brine MP and Maggie Throup MP have both called for funding to expand opt-out in the House of Commons.

The Scottish National Policy passed a motion in August 2023 that made the expansion of opt-out testing party policy.

Every day that passes, we're missing opportunities to test and find more people living with HIV. There is a groundswell of support to expand this incredible programme.

There cannot be further delay – the governments in England and Scotland must fund the expansion of opt-out testing in A&Es now.