The programme, introduced in 2022 in emergency departments in areas of very high HIV prevalence, offers HIV, hepatitis B and C testing to all eligible patients having blood tests unless they choose to opt out.
The programme’s aim is to identify people living with HIV or hepatitis who may not otherwise access testing, helping them start treatment earlier and reducing the risk of serious illness. People on HIV treatment can live a normal lifespan and cannot pass the virus on.
What the study found
Researchers from Bristol’s NIHR Health Protection Research Unit (HPRU) in Evaluation and Behavioural Science evaluated the first 33 months of HIV testing conducted within the programme across 34 emergency departments in England. They found during this period:
- More than 2.7 million HIV tests were carried out
- 802 people received a new HIV diagnosis
- Most people diagnosed through the programme had no record of a previous HIV test
- Many were diagnosed at a late stage of infection, when health risks are greatest
Using a mathematical model, the researchers estimated that the programme will prevent around 187 HIV-related deaths and 28 onward HIV infections over the next 20 years by diagnosing people earlier and linking them to care.
The study also found that the programme represents good value for money for the NHS primarily because earlier diagnosis allows people to start life-saving treatment sooner, improving health outcomes and reducing onward transmission. This estimate is conservative as it does not account for the benefits of identifying people with hepatitis B and C through the programme.
The researchers concluded that emergency department testing is helping to identify a largely hidden population of people living with undiagnosed HIV and is contributing to England's goal of ending new HIV transmissions by 2030.
Dr Josephine Walker, Senior Lecturer in Health Economic Modelling and lead author at the University of Bristol and NIHR HPRU, said: “At around £6 per HIV test, and even though a large number of tests are required to identify one undiagnosed person living with HIV, the programme is good value for money for the NHS. Importantly it has led to linkage to treatment to improve the health and lifespan of many people who were previously living with undiagnosed HIV.”
Professor Francesca Swords, National Medical Director for the NHS, added: “Knowing your HIV status is as important as checking your blood pressure, so it fantastic that our pioneering NHS Opt-out Testing Programme is helping us provide hundreds of previously unaware people with a diagnosis and access to life-saving treatment.
“The NHS is committed to improving early detection of HIV and other blood borne viruses and improving awareness of these health conditions to reduce the chance of unknown transmissions to others.”
“Rolling out this Opt-out testing initiative in EDs is an excellent example of how the NHS is working hard to make every contact with patients matter, when it comes to supporting people to stay well, save lives, while also making the best uses of its resources.”
Dr Tamara Djuretic, Consultant Epidemiologist and Head of HIV Section at UKHSA, said: “NHS opt-out testing in emergency departments is helping to reach people who don’t realise they’re living with HIV or other blood-borne viruses. Many of these people might not have been tested otherwise.
“This new research underscores the programme’s long-term value - earlier detection of HIV not only improves individual health outcomes and saves lives but also supports wider public health HIV prevention efforts.”
Katie Clark, Head of Policy at Terrence Higgins Trust, explained: “This routine approach to HIV testing in emergency departments has been game changing. We now have very clear evidence that not only does this front-footed approach mean we are diagnosing people who are unlikely to be tested anywhere else, but also that it's excellent value for money.
“The continuation of opt-out HIV testing is crucial as we work to end new HIV cases in England by 2030 and ensure no one – regardless of gender, ethnicity or location – is left behind. The next step is to take the same approach to GPs in areas with a very high HIV prevalence."
For more information on HIV testing services, visit nhs.uk website
Paper
‘Cost-effectiveness of emergency department opt-out testing for HIV in England: a modelling study’ by Josephine G Walker, Jeremy Horwood, Matthew Hickman et al. in The Lancet HIV [open access]