Open Letter to fund opt-out testing in more A&E departments

Dear Neil O’Brien and Amanda Pritchard,

The government has set ambitious targets to end new HIV transmissions by 2030 and eliminate hepatitis C in England by 2025. To do this, testing for HIV and hepatitis must become routine across the country. We are writing to ask that you extend the government’s opt-out HIV and hepatitis testing programme to all areas of ‘high’ HIV prevalence outside of London.

Opt-out blood borne virus testing is saving lives and saving money. In London, central Manchester, Brighton and Blackpool, more than 360 people have been newly diagnosed with HIV or re-engaged in care in just nine months. They can now access effective treatment that means they can live a healthy life and can’t pass on the virus. Many were already unwell but hadn’t been tested before.

In the same time, 727 people have been diagnosed with Hepatitis B and 315 with Hepatitis C. An estimated 40-50% of those with viral hepatitis are undiagnosed - we must find these people and ensure they can access the care they need. Opt-out testing is doing just this, on a remarkable scale.

It’s also not a coincidence that people diagnosed in emergency departments through opt-out testing are more likely to be Black African, women or older people – groups who are at higher risk of being diagnosed late. 45% of people diagnosed with HIV in the first opt-out testing pilots were of Black African, Black Caribbean or Black ‘other’ ethnicity, more than twice as many as the nationwide average of 22%. A further 35% were women and 10% aged 65 or over. This is because opt-out testing is finding people who are less likely to access a sexual health clinic or to be offered a test if they do go.

That’s why we can’t stop here. Areas outside of London that are classed by the UK Health Security Agency as having a ‘high’ HIV prevalence – including Birmingham, Portsmouth, Derby and Peterborough – should also benefit. Opt-out testing more than pays for itself, but these areas need funding to get started. An estimated £18 million is needed to expand opt-out blood borne virus testing to just over 40 emergency departments in 32 local authority areas.

In the first 100 days, the programme in the highest prevalence areas has so far cost £2 million but saved the NHS an estimated minimum of £6-8 million in care costs. It is also relieving pressure on other parts of the health service. In fact, in Croydon University Hospital, when they first started opt-out testing the average hospital stay for a newly diagnosed HIV patient was 34.9 days. After two years of opt-out HIV testing, the average stay is now just 2.4 days.

We could be the generation that ends new HIV transmissions and eliminates Hepatitis C in England. We have all the tools we need and we know what works. We urge you to seize this opportunity and make the funds available to make opt-out testing available in more areas.

Yours sincerely,

Deborah Gold, Chief Executive, National AIDS Trust
Ian Green, Chief Executive, Terrence Higgins Trust
Anne Aslett, Chief Executive, Elton John AIDS Foundation
Pamela Healy, Chief Executive, British Liver Trust
Rachel Halford, Chief Executive, Hepatitis C Trust