Latest NHS data shows 1,900 previously undiagnosed cases of HIV have been identified by the NHS Blood Borne Virus Opt-Out Testing Programme, since it began in April 2022.
Under the first-of-its kind large scale NHS programme, adults visiting a major hospital ED in 88 towns and cities with a high rate of diagnosed HIV, who are having blood taken as part of their visit are also routinely tested for HIV and hepatitis B & C unless they choose to opt-out.
If someone’s test comes back positive for HIV (or hepatitis B or hepatitis C) -the person is offered specialist support from the NHS, and a treatment plan is agreed with them.
Almost all (93%) newly diagnosed individuals by the programme had no record of a prior HIV test, according to research by the UK Health Security Agency (UKHSA), which health chiefs believe shows the initiative is reaching people who are unlikely to be tested routinely through other routes.
Meanwhile, a major new economic evaluation study- published in The Lancet HIV and led by the University of Bristol and National Institute for Health and Care Research (NIHR) estimates that the 802 new diagnoses from the programme’s initial phase will prevent around 187 HIV-related deaths and 28 new infections over the next 20 years.
One person whose previously unidentified HIV was found by the NHS ED Opt-Out Testing Programme is Ayo from Manchester, who is in his 50s. From November 2022, Ayo experienced nerve pains throughout his body and numbness in his face. He was off work, unable to perform his job and his plans to go to university were put on hold.
Over time, Ayo’s condition deteriorated further. He lost 20 kilograms in weight and the neuropathic pain continued. Eventually, very unwell with a high fever and an abscess on his neck, he was rushed to Manchester Royal Infirmary’s Emergency Department.
It was there that Ayo was tested for HIV as part of the NHS Blood Borne Virus Opt-Out Testing Programme, and his test result came back positive.
Ayo, said: “If I wasn’t in hospital, I wouldn’t have been tested for HIV. It wasn’t something I thought would affect me in my fifties, but in the blink of an eye, everything changed.
“Now I know my status, I can protect my wife and stay well for my family.
One in 20 people living with HIV in England don't know they have it, and many others are only diagnosed after the virus has already caused serious damage to their health.
Professor Francesca Swords, National Medical Director for the NHS said: “Knowing your HIV status is as important as checking your blood pressure; and our pioneering NHS Blood Borne Virus Opt-Out Testing Programme is helping hundreds of people get a diagnosis, often before they have any symptoms at all, which means they have access to life-saving treatment.
“NHS staff are committed to improving early detection of HIV and other blood borne viruses; and improving awareness of these health conditions to reduce the chance of people unknowingly passing it on to others.
“The successful rollout of this initiative in hospital EDs is an excellent example of how the NHS is working to make every contact with patients matter by supporting people to stay well, access treatment, save lives, and making the best uses of its resources.”
The HIV Action Plan 2025-2030, published by DHSC in collaboration with UKHSA and NHS England, sets out the government’s approach to end new HIV transmissions within England by 2030. It will continue the success of the blood-borne virus ED opt-out testing programme, investing £156 million from April 2026 to March 2029 to deliver opt-out HIV, Hepatitis B and Hepatitis C testing in (EDs) in very high and high HIV prevalence areas.
Today’s economic evaluation study also found the programme delivers good value for money for the NHS because of its low cost; and that earlier diagnosis allows people to start life-saving treatment sooner, improves health outcomes and reduces onward transmission.
Dr Josephine Walker, lead author at the University of Bristol & NIHR Health Protection Research Unit in Evaluation and Behavioural Science, said: “At around £6 per HIV test the programme is good value for money for the NHS, and importantly has led to linkage to treatment to improve the health and lifespan of many people who were previously living with undiagnosed HIV.”
The study researchers say their findings provide evidence to support the continuation of opt-out testing in emergency departments as part of the Government’s HIV action plan- which aims to achieve zero new HIV infections or AIDS related-deaths in England by 2030.
Professor Marian Knight, Scientific Director for NIHR Infrastructure, said: "To end HIV transmission, we have to make it as straightforward as possible for people to be tested wherever easiest for them. This ED testing scheme is doing exactly that - finding hundreds of unidentified HIV cases among people who may never have otherwise sought a test.
“Research supported by two of our NIHR Health Protection Research Units shows that this is a highly cost-effective intervention. This marks a critical pivot from sickness to prevention, protecting communities who need it the most."
NHS leaders are continuing to rollout the programme to help more people unknowingly living with HIV; and a further three new hospitals will start offering testing to their ED patients by April 2027.
Katie Clark, Head of Policy at Terrence Higgins Trust, said: “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.