PRESS RELEASE : New research into expansion of life-saving HIV testing programme [January 2024]

• A new £20 million National Institute for Health and Care Research (NIHR) project will support the government’s ambition to end new transmissions of HIV within England by 2030 and get people into the right care
• Undiagnosed HIV, hepatitis B and C will be picked up in new testing programme in 47 more emergency departments in 32 high HIV prevalence areas of England
• Expansion comes after success of schemes in extremely high prevalence areas of HIV, identifying almost 4,000 people with a bloodborne virus (BBV) since April 2022

A new research project to evaluate an expansion of the hugely successful HIV opt-out testing programme to new sites across England, has today been announced (29 November 2023). Given the success of the existing testing programme, this new initiative is expected to save, and improve the quality of, thousands of lives.

Backed by £20 million of NIHR funding, the research will evaluate the testing programme in 47 new sites across England. Expansion of the programme could identify a significant proportion of the estimated 4,500 people living with undiagnosed HIV – preventing new transmissions and saving more lives through testing people’s blood already being taken in emergency departments for bloodborne viruses (BBVs), including HIV and hepatitis B and C.

Last year, as part of the government’s world leading HIV action plan for England, NHS England launched the BBVs opt-out testing programme, with funding available for 34 emergency departments in areas with the highest prevalence of HIV. Today’s announcement will mean the programme will be expanded as part of a research evaluation in all 47 emergency departments covering 32 areas with high prevalence of HIV.

It will support the UK’s progress in being a world leader in the fight against HIV – and in meeting its goal to end new transmissions of HIV within England by 2030.

Health and Social Care Secretary, Victoria Atkins, said:

Less than 3 decades ago, HIV could be a death sentence. It was often – and wrongly – considered a source of shame, and diagnoses were hidden from friends, family and society. But today, thanks to effective treatments, it is possible to live a long and healthy life with HIV.

As well as promoting prevention for all, the more people we can diagnose, the more chance we have of ending new transmissions of the virus and the stigma wrongly attached to it.

This programme, which improves people’s health and wellbeing, saves lives and money.

The evaluation of the expansion of opt-out testing will help reach the government’s bold ambitions of reducing new HIV transmissions by 80% in 2025 and ending new transmissions by 2030, according to an update on the HIV action plan for England.

The existing programme in extremely high prevalence areas has been shown to be highly effective in identifying HIV in people unaware they had the virus and re-engaging those who are not in HIV care. The programme provides linkage to medication, a treatment and care pathway which enables people to live long and healthy lives, where the virus is undetectable.

During the first 18 months of the BBVs opt-out testing programme, 33 emergency departments conducted 1,401,866 HIV tests, 960,328 hepatitis C virus (HCV) tests and 730,137 hepatitis B virus (HBV) tests significantly increasing the number of bloodborne virus tests conducted in England each year.

It has identified:

• 934 people living with HIV or people disengaged from HIV care
• 2,206 people living with HBV and 388 disengaged from HBV care
• 867 people living with HCV and 186 disengaged from HCV care

Professor Kevin Fenton, government chief adviser on HIV and chair of the HIV Action Plan Implementation Steering Group, said:

We know HIV is most commonly unknowingly spread by people who don’t know their status. Knowledge is power in preventing HIV transmission and accessing life-saving care.

The core ambitions of our world-renowned HIV action plan are to intensify HIV prevention, expand HIV testing, strengthen linkage to and retention in high quality HIV care, and tackle HIV stigma and discrimination. We will not give up this fight until there are no new HIV transmissions in England.

The opt-out testing programme will boost our progress to identify the estimated 4,500 people who could be living with undiagnosed HIV and help us ensure we meet our 2030 ambition, with the possibility to save thousands of lives in the process.

Outside of BBVs opt-out testing, progress is also being made. There are fewer people living with undiagnosed HIV and, as a result of effective treatments, it is possible to live a long and healthy life with HIV. Most people with HIV diagnoses are receiving world class treatment, making it undetectable.

There is much to celebrate, ahead of World Aids Day (1 December), on the government’s progress towards its action plan ambitions, with fewer than 4,500 people living with undiagnosed HIV – the lowest it’s ever been since recording begun – and extremely high levels of antiretroviral treatment, used to treat HIV, and viral suppression.

In 2022, England once again achieved the UN AIDS 95-95-95 target nationally: 95% of people living with HIV being diagnosed, 98% of those diagnosed being on treatment and 98% of those on treatment having an undetectable viral load – meaning the levels of HIV are so low that the virus cannot be passed on.

In a speech this evening at the All Party Parliamentary Group on HIV and AIDS event, Health and Social Care Secretary Victoria Atkins thanked the ongoing dedication from NHS staff, HIV charities, the UK Health Security Agency (UKHSA), local government and professional bodies and campaigners, which have worked tirelessly to support the government in achieving its goal to end new transmissions.

People with reactive or positive tests results are linked to care and offered information and support through community organisations.

The opt-out strategy for BBVs testing is important to address health inequalities by reaching groups, such as those from ethnic minorities or women, who are less likely to attend sexual health services and may be disproportionately affected both by higher rates of some BBVs and stigma associated with BBVs testing or diagnosis.

Opt-out testing additionally provides a valuable opportunity to re-engage with people who have previously been diagnosed with a BBV but who are not accessing treatment or care.

Anne Aslett, CEO of the Elton John AIDS Foundation, said:

The Elton John AIDS Foundation launched the first HIV Social Impact Bond in 2018 because too many vulnerable people were being left behind. Together with our partners, we identified opt-out testing in emergency departments as an effective and cost-saving way of ensuring people living with HIV get the treatment they needed.

We warmly welcomed the government’s decision to expand this successful method of HIV diagnosis to 33 sites in April last year and results from the last 18 months demonstrate how incredibly important this approach is to ensure no one is left behind. Today’s announcement to further expand opt-out testing to 47 additional emergency departments is another fantastic and very significant step towards meeting the goal of ending new HIV transmissions by 2030 and above all else will save lives.

Richard Angell, Chief Executive of Terrence Higgins Trust, said:

Today’s announcement is the testing turbo boost that’s needed if we are to end new HIV cases by 2030. It’s hugely significant that an additional 2 million HIV tests will be carried out in A&Es over the next year thanks to a temporary but wholesale expansion of opt-out HIV testing to 47 additional hospitals. With this landmark investment, opt-out HIV testing in A&Es will account for more than half of all tests in England. This major ramping up of testing is absolutely crucial to find the 4,400 people still living with undiagnosed HIV.

The evidence is crystal clear: testing everyone having a blood test in emergency departments for HIV works. It helps diagnose people who wouldn’t have been reached via any other testing route and who have often been missed before. It also saves the NHS millions, relieves pressure on the health service and helps to address inequalities with those diagnosed in A&E more likely to be of black ethnicity, women and older people.

Professor Lucy Chappell, chief scientific adviser at DHSC and CEO of NIHR, said:

Health and care research is at the heart of every significant improvement we make to testing, treating and curing illness and disease. It brings huge benefits to patients and the public.

By expanding this already successful opt-out scheme as part of a research project, not only are we delivering it to new parts of the country, but we can gather more useful evidence for the future.

Professor Sir Stephen Powis, NHS National Medical Director, said:

The NHS’s opt-out testing programme in emergency departments has meant we have identified and treated thousands more people living with HIV and hepatitis B and C, particularly from groups who are less likely to come forward for routine testing.

Without this NHS testing programme, these people may have gone undiagnosed for years, but they now have access to the latest and most effective life-saving medication, helping to prevent long term health issues and reducing the chances of unknown transmission to others.

This NHS success story is a prime example of how we are taking advantage of every opportunity to support people to stay well, prevent illness and save lives.

Dr Alison Brown, interim head of HIV surveillance at UKHSA, said:

We know that HIV testing saves lives and prevents onward transmission, but progress has been uneven. The continued lower rates of HIV testing and PrEP among women and ethnic minority groups is concerning.

This research project will help provide greater access to testing of HIV, as well as hepatitis B and C, among populations who may not otherwise access testing. It will also help England meets its ambition to end HIV transmission by 2030.

Florence Eshalomi MP, co-chair of the APPG on HIV/AIDS, said:

We are delighted that the government today has taken concrete steps to increase and normalise HIV testing in the UK. The APPG believes that as Parliamentarians we should play our part in addressing this epidemic and this is something we have been calling for following the successful roll-out of opt-out to extremely high prevalence areas.

Professor Yvonne Gilleece, chair of the British HIV Association (BHIVA), said:

BHIVA very much welcomes this expansion of the testing programme to other emergency departments in England. It will save lives by identifying many more people who are not yet aware that they have been at risk of acquiring HIV, or other blood borne viruses.

Today we are able to provide effective HIV treatment, which will also prevent onward transmission of the virus, and so take us a step nearer to reaching the 2030 target.

Deborah Gold, chief executive of National AIDS Trust, said:

We are delighted to warmly welcome today’s announcement that HIV testing will now routinely take place in every emergency department in all 33 areas of England with high prevalence of HIV for the next year. This decision, which will more than double HIV testing capacity in England, means that more people will be diagnosed with HIV faster, and will be able to access life-saving treatment which will also stop the virus being passed on.

Routine HIV testing in emergency departments is especially good at finding people who would otherwise not receive a test, most often from marginalised communities who are being left behind in our progress on HIV. With HIV diagnoses rising among women, and stubbornly high levels of late diagnosis among women and people from black African communities, this announcement could not be more timely in making sure we don’t miss vital opportunities to diagnose someone who needs access to HIV care.

This important new research programme, funded by the National Institute for Health and Care Research, will deliver opportunities for greater insights and shared learning alongside their crucial wider HIV research programme.

Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV (BASHH), said:

The expansion of the HIV opt-out emergency department testing programme to include high HIV prevalence areas is hugely welcome and a meaningful step towards our shared ambition to eliminate new cases of HIV in England by 2030.

BASHH is pleased to see the government demonstrating their commitment towards achieving this ambition by allowing those in areas of high HIV prevalence to access the successful scheme. We are grateful to all the hard-working NHS, UKHSA and DHSC staff and politicians who have brought this initiative forward. It is important to thank the vital work of advocacy groups in pursuing the amplification of the testing programme that has already seen thousands of people benefit from its implementation.

Amanda Healy, policy lead for health protection for the Association of Directors of Public Health, said:

Identifying new HIV and hepatitis cases is a crucial part of meeting the target to end HIV transmission by 2030 and today’s announcement is very welcome news.

In addition to identifying new cases so that treatment can be given to avoid illness, it is imperative that efforts to prevent blood borne viruses, including increasing the uptake of PrEP, are continued.

James Woolgar, current chair of the English HIV and Sexual Health Commissioners Group, said:

This is certainly very welcome news in our aim to end all new cases of HIV. The roll out of opt-out emergency department testing will help our collective aim in identifying those people living with undiagnosed HIV, and supporting them into treatment and care. As commissioners, we will work hard with local trusts and charitable sector leads to make this a success.

Background information

The following areas will be covered by the extension of the HIV opt-out testing programme:

• University Hospital Coventry
• Leicester Royal Infirmary
• Luton and Dunstable Hospital
• New Cross Hospital (Wolverhampton)
• Queen’s Medical Centre (Nottingham)
• Milton Keynes University Hospital
• Southend University Hospital and Mid Essex Hospital
• Wexham Park Hospital and Frimley Park Hospital
• Royal Berkshire Hospital
• City Hospital and Sandwell General Hospital (West Bromwich)
• Southampton General Hospital
• Leeds General Infirmary and St James’s University Hospital
• Queen Elizabeth Hospital Birmingham, Good Hope Hospital and Heartlands Hospital
• Royal Derby Hospital and Burton Hospital
• Royal Bournemouth Hospital and Poole Hospital
• Bristol Royal Infirmary and Weston General Hospital
• Queen Alexandra Hospital (Portsmouth)
• Peterborough City Hospital and Hinchingbrooke Hospital
• Walsall Manor Hospital (Birmingham)
• Basildon University Hospital
• Bedford Hospital
• Royal Liverpool University Hospital and University Hospital Aintree
• Royal Stoke University Hospital and County Hospital
• Northampton General Hospital
• Royal Oldham Hospital and Fairfield General Hospital
• Tameside General Hospital
• Northern General Hospital (Sheffield)
• Royal Bolton Hospital
• Kettering General Hospital
• Medway Maritime Hospital
• Royal Victoria Infirmary (Newcastle)
• Conquest Hospital (Hastings) and Eastbourne District General Hospital
• Southmead Hospital (Bristol)