Our team was inspired by the Blood Borne Virus Opt-Out Testing in Emergency Departments: Learn and Share Event in Manchester recently.
The day celebrated progress and called for sustained efforts for the improved diagnosis and care of people infected with blood-borne viruses (BBV) in England. It brought together a wide range of perspectives from strategy and implementation to re-engagement and its impact on individuals’ quality of life.
National strategies for HIV and hepatitis elimination
Senior government public health leaders, Prof. Kevin Fenton and Mark Gillyon-Powell, highlighted the need for a combination of strategies to eliminate HIV and hepatitis C, particularly for underserved populations and low prevalence areas.
Prof. Fenton described the challenges for implementation of the HIV Action Plan, including relatively low access to pre-exposure prophylaxis (PrEP) among black African communities and difficulties for specialist services in maintaining engagement with some people living with HIV who would benefit. However, it was inspiring to hear about initiatives such as the new HIV Prevention England Programme, expansion of HIV home testing, and the potential of the NHS app. The need for combination strategies for HIV elimination is supported by our own modelling results, which indicated that the UK would miss its 2030 HIV transmission target if prevention remained at 2023 levels. However, we have demonstrated that there are interventions that can be effective at working towards the elimination goals, including scaling up testing, providing PrEP to those who could benefit, and timely treatment. These interventions could prevent around 19,400 HIV transmissions between 2024 and 2073 – a 37% reduction compared to maintaining current efforts.
Mark Gillyon-Powell highlighted the often underserved communities of people who live with untreated hepatitis B and C, including people who currently inject or previously injected drugs, and people from abroad who were infected through blood transfusions. He emphasised the importance of funding small-scale learning pilots for opt-out testing (OOT) and the value of political will to drive progress towards hepatitis C elimination.
Evaluation and modelling of BBV OOT programmes and their impact
Findings from England’s national BBV OOT programme in emergency departments highlighted its effectiveness in identifying undiagnosed infections and facilitating linkage to care. Between April 2022 and December 2024, over 7 million tests were conducted across 34 emergency departments, identifying 3,667 new HBV, 831 HCV and 719 HIV diagnoses. Approximately half (52%) of those testing positive for hepatitis were newly diagnosed, compared with 8.3% for HIV. Importantly, 62.8% of eligible individuals had no record of previous BBV testing, underscoring the potential of OOT to reach populations who might otherwise remain untested. These findings resonate strongly with our own modelling across multiple European countries (including Germany and Poland), which similarly suggest that BBV OOT in emergency departments can improve clinical outcomes and be cost-effective, even under conservative assumptions.
Re-engagement and the importance of peer-support
The event also highlighted that testing is only one part of the pathway for preventing illness and deaths. Successful programmes depend on strong linkage to care and collaboration across services to ensure that people identified through testing receive the support and care they need. The George House Trust in Manchester shared their experiences and impact from having peer navigators and intensive support workers embedded in NHS services in a collaborative approach. It was incredibly moving to hear from a patient how peer support had enabled them to tackle stigma and mental health issues and to stabilise their antiviral treatment – it was incredible that until then, they had spent 20 years living with HIV without ever talking to someone else living with HIV. It is important that we build the evidence base for engaging with and supporting people who have been previously diagnosed but who are not engaged in care. We need to better understand the health, economic (and ideally social) benefits, and the costs that arise from re-engagement and consider this in our strategies and models for BBV OOT.
Call for action
We need to strengthen the evidence base to help inform national and international policy on the wider implementation of BBV OOT, re-engagement, and combination strategies to achieve global HIV and viral hepatitis elimination goals.
So that we can plan elimination strategies with evidence-informed options, our call to action now is for:
- Real-world studies of BBV OOT in European emergency departments and other settings in line with European guidelines to assess the local feasibility and inform roll-out.
- Further pilots of interventions to reconnect with people living with BBV who have disengaged from services, with definition and categorisation of those interventions, and evaluation of their costs and effectiveness.
- Modelling and scenarios to guide the planning of a combination of strategies required to achieve elimination with a focus on underserved population groups and low prevalence areas.
Thank you to everyone involved in organising and contributing to such an insightful day.
We’ll be attending HIV Drug Therapy Glasgow and HepHIV by EuroTEST later this year, so if you’re interested in our work on modelling HIV elimination strategies and BBV OOT across Europe, please come and say hello