The UK Government has set a goal of ending new HIV and Hepatitis C transmissions in England by 2030 and provide people who test positive with the right care. Better prevention, detection and treatment are required to eliminate new infections.
Significant inequalities exist in identifying and treating those living with Blood Borne Viruses BBV (HIV, Hepatitis B and Hepatitis C) and addressing these inequalities is paramount to achieve elimination targets. Tackling these challenges requires reaching those who do not test in traditional settings such as sexual health clinics, so people with BBV can be identified early and given medication before the viruses damage their body.
It is important to test regularly for HIV, as if you are diagnosed late, the virus may have already started to damage the immune system. A person living with HIV has a similar life expectancy to an HIV-negative person – if they are diagnosed early and regularly take their HIV medication. People living with HIV and regularly taking HIV medication (reducing the amount of virus to ‘undetectable’ levels) cannot pass HIV on through sex, so it is vital that people are tested to know if they have HIV and can be given HIV medication. Hepatitis B and C are both virus that can infect the liver. Hepatitis C can be treated successfully by taking medicines for several weeks.
To increase access to BBV testing and the number of people diagnosed and in treatment and care, in April 2022 NHS England launched the BBV opt-out testing programme in emergency departments in areas with very high prevalence of HIV. Anyone aged 16 years and over attending an emergency department in these areas and having a routine blood test is automatically tested for HIV, hepatitis B and C, unless they opt-out
HPRU BSE University of Bristol colleagues in collaboration with UKHSA have been evaluating the programme. During the first year, 33 emergency departments conducted 857,117 HIV tests, 473,723 HCV tests, and 366,722 HBV tests – significantly increasing the number of BBV tests conducted in England each year. It has identified nearly 2,000 people living with a bloodborne virus – 499 with hepatitis C, 1143 with hepatitis B and 341 with HIV.
Backed by £20 million NIHR funding the BBV opt-out testing programme is being extended to an additional 47 sites across England in areas of high HIV prevalence in 2024. The HPRU BSE will continue to evaluate the impact of the programme.
Research team and plan
Professor Jeremy Horwood and Professor Matt Hickman – Co-principal investigators
Rachel Todd, HPRU BSE Programme Manager
Robyn Heath, Study Coordinator
Workstream 1: Qualitative Implementation Optimisation
To improve how the testing is carried out and how people who test positive are supported to receive care, we will examine how the testing is working and if it could be improved. We will survey sites to identify site-specific organisational procedures (e.g. staffing responsibilities, training provision) and localised testing and care pathways (e.g. involvement of community organisations). We will also conduct observations/ interviews with ED staff and patients to understand individuals experience of opt out testing. Finally, we will work with community organisations that are supporting patients testing positive to engage in care. We will interview community organisation staff and the patients they are working with to identify likely mechanisms leading to positive or negative outcomes for different people in in different settings. Our findings will help to identify best practices for optimising implementation and supporting and retaining people in care through opt-out ED testing.
Dr Tom May – Workstream 1 co-lead, University of Bristol
Prof Jeremy Horwood, Workstream 1 co-lead, University of Bristol
Siobhán Allison, University of Bristol
Dr Jo Kesten, University of Bristol
Dr Catherine Lowndes, UKHSA
Dr Emily Nicholls, HPRU BBV-STI, UCL
Prof Caroline Sabin, HPRU BBV-STI/UCL
Prof Lucy Yardley, University of Bristol
Workstream 2: Public Health Evaluation
To check if BBV testing is working well, we will look at data collected regularly from each emergency department. We will count how many people should get tested, how many actually do, who gets diagnosed (especially if it’s their first time), who goes to get help (if they just found out or knew about their infection before), and who continues to get help. We will also see if there are any differences in testing and being diagnosed by age, gender ethnicity, deprivation what risks they have, and their health status. Also, we will compare how well this new way of testing works with the old way that offered testing to people based on their risk in the year before starting ED BBV opt-out testing.
Dr Sema Mandal, Workstream 2 co-lead, UKHSA
Dr Monica Desai, Workstream 2 co-lead, UKHSA
Dr Alison Brown, UKHSA
Tom Clare, UKHSA
Dr Catherine Lowndes, UKHSA
Rachel Roche, UKHSA
Prof Caroline Sabin, HPRU BBV-STI/UCL
Dr John Saunders, UKHSA/ HPRU BBV-STI
Dr Ruth Simmons, UKHSA
Workstream 3: Cost-effectiveness Analysis
To see if it’s worthwhile to do more ED BBV opt-out testing, we will look at how much it costs and if it improves people’s health compared to the previous way of offering tests in ED. We will use mathematical models to simulate how the diseases progress and estimate long-term benefits in prevention of ill health caused by HIV, HBV, and HCV. These models will use information from each ED on how many people get tested, how many new people are diagnosed, and how much the extra testing costs. The cost-effectiveness analysis will help the NHS decide if it’s good value for money to do this testing in ED. We will also look at different possibilities to see how the value for money changes if there are more or fewer people with each disease.
Prof Peter Vickermen, Workstream, 3 co-lead, University of Bristol
Dr Josephine Walker, Workstream 3 co-lead, University of Bristol
Dr Asra Asgharzadehkamachali, University of Bristol
Dr Zoe Ward, University of Bristol
Outputs
https://www.gov.uk/government/publications/bloodborne-viruses-opt-out-testing-in-emergency-departments/emergency-department-bloodborne-virus-opt-out-testing-12-month-interim-report-2023