Patients in Emergency Departments (EDs) in all London NHS hospitals will now be offered HIV tests, as NHS England announces the expansion of opt-out routine testing across London.

While some trusts have already been implementing opt-out HIV testing, successfully identifying undiagnosed HIV and offering effective early treatment, the initiative has now expanded to every NHS trust in London. Hepatitis B and C will also be checked as part of the combined blood borne virus testing approach.

With 42% of HIV diagnoses in the UK made late, at a point when the immune system has already been significantly damaged, early identification is key in preventing ill-health, premature death and onward transmission. People with a late diagnosis are eight times more likely to die from the illness.

In 2020 across England, 29% of gay and bisexual men were diagnosed late, compared with 59% of Black African heterosexuals. ED opt-out HIV testing is an effective way to reach members of these communities, who may not come into contact with other HIV testing opportunities.

In London, more than 1,600 people were living with undiagnosed HIV in 2020, which is around a third of the estimated number of people in the UK who are not aware they have the virus.

Oliver Brown, serving in the Royal Navy, said:

“I was 29 when I went to A&E after coming off my bike with one of my fingers badly sliced during the fall.

“Had Chelsea and Westminster Hospital not been part of a routine HIV opt-out testing programme in Emergency Departments, I may still be unaware of my status.

“As a naval officer, I faced challenges following my diagnosis, fearing the stigma associated with being HIV positive. However, through engaging and educating, the blanket ban on people with HIV being able to serve our country has been lifted and now individuals taking medications such as ART and PrEP are recognised as fully fit to serve in our Armed Force.

“Routine opt-out testing in A&E departments saves lives, it saved mine and stopped me passing on the virus to others.”

Since HIV opt-out testing became routine in some EDs in 2016, HIV diagnoses have significantly increased, detecting patients who otherwise may not have found out they were positive until later.

At West Middlesex University Hospital, 66% of new HIV diagnoses within the last year have come from testing in EDs.

Croydon University Hospital began opt-out testing for HIV in early 2020 and have managed to sustain a 97% testing rate for over two years.

Ward patients presenting with AIDS-defining illnesses in Croydon have halved in number since 2019 and are two-thirds fewer than a decade ago.

Dr Ian Cormack, clinical lead at Croydon University Hospital said:

“Emergency Department testing is a brilliant initiative that means more patients get support and treatment right away, preventing the development of serious AIDs-defining illnesses and ultimately saving lives. At Croydon this has tripled our hospital’s rate of HIV diagnosis and has dramatically improved patient outcomes.

“It’s so important because very few people expect to test positive, and without this testing initiative they may not have been diagnosed until they become very unwell. Death or significant harm from HIV is now mostly a thing of the past thanks to earlier diagnosis and treatment.

“HIV treatment ensures good health and also prevents onwards transmission, helping the UK achieve its target of eliminating new HIV infections by 2030.”

The Government’s Chief HIV Advisor and Chair of the HIV Action Plan Implementation Steering Committee, Professor Kevin Fenton said:

“Offering this routine testing in all Emergency Departments in London is a key step towards our shared ambition of ending new HIV transmissions in England by 2030, as we know it is one of the most effective ways to identify new cases of HIV, linking those diagnosed to valuable, life-saving care.

“As part of the government’s HIV Action Plan, we are working to ensure that the estimated 4,660 people living with HIV in England in 2020 but unaware of their HIV status, are tested, diagnosed, and offered treatment.

“It is essential that we maintain our focus on prevention, testing, access to high quality care and tackling HIV stigma, working with partners across the health system and beyond, to reach our shared ambition of ending HIV transmission.”

Professor Jane Anderson, Co-Chair of Fast-Track Cities London said:

“Fast-Track Cities London is proud to support the roll-out of HIV testing in all emergency departments in London. An opt-out approach is the best way to make sure the huge benefits of HIV testing reach as many people as possible.

“An HIV test is the gateway to good health – if someone tests positive there is excellent lifesaving treatment, and a negative test means access to a full range of prevention methods. This is a great step on the road to London being the first city in the world to eliminate HIV all together.”

Minister for Public Health, Maggie Throup said:

“We are leading the way in stamping out HIV. As part of our HIV Action Plan, the expansion of opt-out testing across the capital is a further step to identifying undiagnosed HIV. This will ensure people get the right treatment as early as possible and will help eliminate this cruel disease for future generations.

“We’ve made excellent progress already with transmissions continuing to fall across England and we are well on our way towards our ambition of zero HIV transmissions and deaths by 2030.”

NHS Medical Director in London, Dr Chris Streather said:

“The NHS in London is committed to increasing early detection diagnoses of HIV, to ensure people have access to the life-saving medication which prevents long-term health issues and reduces the chance of unknown transmissions to others.

“The opt-out HIV, Hepatitis B and C testing in Emergency Departments offers patients already in hospital care in London, the chance to check on their health without an additional trip.

“Offering this routine testing in all EDs in London is fantastic, so we can identify those who may not know they are living with HIV, get them the treatment to live long healthy lives and avoid future inpatient NHS care.”

Of the NHS England London region allocation, £5m has been distributed to the five Integrated Care Systems to fund this initiative across the capital.

As part of the prevention agenda, NHS England is committed to the government ambition of achieving zero HIV transmissions by 2030. The government HIV action plan committed £7m annually to EDs to introduce opt-out HIV testing in the highest prevalence areas.