Opt out blood borne viruses (BBV) testing in emergency departments, one year on

April 2022 saw opt out testing for blood borne viruses (BBV) in emergency departments go live. Rachel Hill-Tout, the BBV clinical lead for the project, reflects on progress over the first year.

On World AIDS Day 2021, £20 million funding was provided to expand opt out testing for HIV in Emergency Departments (ED) in areas with the highest HIV prevalence rates. This is a proven way to diagnose people living with HIV and re-engage people with HIV care. It was the first new funding for HIV testing in nearly a decade and formed an important part of the government’s HIV Action Plan, to end new cases of HIV by 2030.  In partnership with the HCV Elimination program at NHS England, testing was expanded to include hepatitis B and C.

It was phenomenal news for the HIV sector which had campaigned hard for the funding. You may not know this but opt out HIV testing has been routine in antenatal care since 2000, with an uptake of over 99%, with the testing eliminating mother to child transmission of HIV; Or that Trusts in the UK have been piloting opt out HIV testing in EDs since around 2010.  The landmark “Going Viral” campaign in nine EDs in 2014 and subsequent pilot studies in London and Dublin demonstrated the effectiveness and feasibility of a combined BBV opt out testing approach.

Over the last decade more and more Trusts have implemented opt out testing, with 20 sites offering HIV opt out testing in EDs in London, Manchester and Blackpool by April 2022 with some also offering HBV and HCV testing.  These pioneer Trusts were pivotal in developing standardised processes for testing, results management and maximising testing uptake.  It’s thanks to their hard work and learning on the implementation of opt out HIV and BBV testing, which allowed us to expand the testing so quickly.

The first year’s data is enormously encouraging. 33 EDs now provide BBV opt out testing. .  This has resulted in around 2000 people living with a BBV being newly diagnosed and finding over 470 who had previously been diagnosed with a BBV but were not in care. These individuals are being linked to care, treatment and community support. These figures are staggering and extraordinary, demonstrating the feasibility and effectiveness of this approach.

Learning from COVID-19, allowed the rapid implementation of new ways of working where we developed collaborative and dynamic partnerships to maximise testing, uptake, linking people to holistic medical care and community support. That said there’s still more to do.  We have 95% target for the uptake of testing across all sites.  We’re not there yet, however, several sites are already hitting the target which is encouraging news.  It’s this learning we now need to share with other services.

As an HIV doctor I’ve cared for many people suffering the devastating effects of a late HIV diagnosis.  What’s amazing to see is the huge difference the ED testing has made to people’s lives, particularly those least likely to access testing in sexual health services or with their GP. Stigma, discrimination, lack of awareness and heath inequalities remain major barriers to our efforts to end HIV and BBV transmissions. This strategy of normalising HIV and BBV testing in front line settings is an important step to address these barriers and should be celebrated, but we know there is much more to be done. The success of the program is thanks to the hard work and dedication of hundreds of people across the NHS, local and national government and the voluntary and charity sector, in particular NHS clinicians, ICS leads, public health officials, DHSC and NHS England colleagues, and the incredible work of THT, NAT, EJAF, the Hep C Trust, the wider HIV and Hepatitis C sector and its supporters– this would not have been possible without you.

Rachel Hill-Tout

Blood borne viruses (BBV) clinical lead.