In April 2022, the NHS made £20 million available over three years to implement routine HIV opt out testing within 33 hospital Emergency Departments, in areas with the highest rates of diagnosed HIV.
Latest NHS data shows the programme is already having success, with 834 newly identified cases of people living with the HIV, Hepatitis B or Hepatitis C found between April and September following its launch – while 153 people, who were previously diagnosed, but were not receiving NHS care, were also identified.
Under the programme, people visiting an Emergency Department are offered a discreet test which screens for the HIV, Hepatitis B and Hepatitis C viruses when full bloods are taken. If the test comes back positive for the HIV, Hepatitis B or Hepatitis C viruses, the person is offered specialist support and a treatment plan is put in place for them.
Data shows that more than two fifths (42%) of HIV diagnoses in the UK are made late, at a point when the immune system has already been significantly damaged. Research suggests that people who get a late HIV diagnosis are eight times more likely to die from the illness, so early identification is key in preventing ill-health, premature death and onward transmission.
The move follows the NHS striking a series of deals for the latest HIV drugs, including a long-acting injection and the first oral drug to combat the disease, as part of its efforts to become the first country in the world to stop new cases of HIV before 2030, by offering a full armoury of HIV-busting drugs.
Professor Sir Stephen Powis, NHS National Medical Director, said: “The NHS is committed to increasing early detection diagnoses of HIV hepatitis and other blood borne viruses, to ensure people have access to the latest and most effective life-saving medication, which prevents long-term health issues and reduces the chance of unknown transmissions to others.
“The roll out of testing in A&Es is a great example of how the NHS is working to make every contact with patients count when it comes to supporting people to stay well and prevent illness, saving lives and money in the long run.
“This targeted programme builds on the testing already routinely available through GPs and sexual health services in every part of the country, so if you think you may be at risk of infection, please don’t delay and come forward for a test as soon as possible so the NHS can set you on the road to recovery.”
Following early success for the initiative in detecting HIV, it was widened to include testing for Hepatitis B and C.
Health chiefs believe ED opt-out HIV and Hepatitis testing is an effective way to reach people who may not otherwise come into contact with other blood borne virus testing opportunities, such as sexual health clinics.
One person who has benefited from routine HIV testing in Emergency Departments is Anne from London, who is in her 50s. Anne tested HIV positive at her tested HIV positive at her local Emergency Department in South London.
Anne said: “If I became sick or ill, I’d take paracetamol, ride it out, I was always fine. However, this one night my approach wasn’t working and I didn’t really know what was going on.
“You could say I was delirious, sweating, I thought it was menopause related. It became so bad my boys took me to A&E, which I don’t remember. When I came round, I was dazed, confused and in agony. I had all manner of blood tests, a lumber puncture, I was then told I had HIV.
“Routine testing at A&E was a blessing,” says Anne, “I’m alive and well, I have medication which keeps me healthy and stops me from passing the virus on.
“I know you can get tested in a sexual health clinic, but I don’t want to go there. The clinic is right off the main road, everyone can see you going in there and I know people would talk. The thing is you wouldn’t ever think you could have it. I’m not promiscuous, I was with one person for the last 10 years, why would I think I’d have it? It isn’t the only way you could get it either, the doctor asked if I had tattoos, I have 4, I don’t know if the needle was clean.
“HIV is common, many people have it and so many people, just like me don’t know they have it. I would always urge people to be tested especially at A&E, it’s discreet no one knows, what have you got to lose? Nothing! But you have everything to live for”.
More than 2,500 people (2,692) were diagnosed with HIV in England in 2021.
Ian Green, Chief Executive at Terrence Higgins Trust, said: “Opt-out HIV testing is already having a big impact in finding people living with undiagnosed HIV, as well as returning many others to HIV care. This innovative and cost-effective approach is so impactful as it reaches people who are very unlikely to test via any other route. That means it is proactively tackling inequalities and benefitting groups who would otherwise only be diagnosed once their health is already significantly impacted. While returning people to HIV care is crucial for ensuring best outcomes for them and preventing onward transmission of HIV. These early results show that opt-out testing for HIV is a crucial part of work to end new HIV cases by 2030.”
As part of England’s HIV Action Plan, the NHS is working to ensure that the estimated 4,660 people living with the virus but unaware of their HIV status, are tested, diagnosed, and offered treatment.
Minister for Public Health Neil O’Brien said: “Our commitment to prevention and public health campaigns have helped to reduce new HIV infections by tackling stigma and urging more people to get tested, as well as accessing life-saving treatment.
“Our £20 million investment in HIV testing in emergency departments in the highest HIV prevalence local authority areas in England has been highly successful. More than 800 people living with HIV and Hepatitis not receiving treatment have been found by the NHS in just six months following the rollout of the routine testing in A&E.
“This is helping us make excellent progress towards the commitments in our HIV Action Plan, with over 259,000 HIV tests being delivered within the first 100 days of delivery.”
Earlier this year NHS took further action to help up to 80,00 more people get potentially life-saving treatment for Hepatitis C by rolling out a new screening pilot scheme.
Under the pilot, the NHS will identify people who might have the virus by searching health records for a number of key Hepatitis C risk factors, such as historic blood transfusions or those with HIV.
Anyone identified through the new screening process will then be invited for a review by their GP, and if appropriate, further screening for Hepatitis C.
Rachel Halford, CEO of The Hepatitis C Trust said: “Testing for blood-borne viruses is essential to help detect, treat and support the elimination of these diseases. The symptoms of hepatitis C are often vague and people are unaware that they have it. If you test positive for hepatitis C, treatment is easy and 95% of people are cured in just a few months.
“By testing at emergency departments, we are able to learn more about the prevalence of blood-borne viruses in the community and work with NHS England and our partners to reduce these numbers and save lives. The high rate of positive hepatitis B and C tests indicates that more must be done to raise awareness of these conditions among the public.
“Although there is a clear pathway for treatment for hepatitis C, we are concerned about the high numbers of positive hepatitis B tests at emergency departments. The government must take steps to understand why this is happening and ensure that hepatitis B treatment is accessible and well-funded.”
