Aims and Objectives On World AIDS Day 2021, the UK Government committed £20 million to expand opt-out HIV testing in EDs in extremely high HIV prevalence (>5/1000) areas as part of their commitment to achieve zero new HIV infections and HIV-related deaths by 2030. 34 EDs in London, Brighton, Greater Manchester and Blackpool were included. The initiative started in April 2022 and expanded to include hepatitis C (HCV) and hepatitis B (HBV) testing in collaboration with the HCV Elimination programme.

Method and Design All adults undergoing blood tests in EDs had BBV testing (4th generation HIV test, HBV surface antigen and HCV antibody with reflex RNA if HCV antibody positive) unless they opted-out. An opt-out approach was taken, based on successful pilots, to maximise uptake and minimise impact on ED workload. Testing information was displayed using accessible and translated posters in EDs. HIV/Sexual Health and Hepatology managed all reactive/positive results.

Results and Conclusion By March 2023, 33 EDs had implemented HIV testing, 25 HCV and 19 HBV. From April 2022 through March 2023 in participating sites there were 1,384,378 ED attendances with blood tests. 853,015 HIV, 346,041 HBV and 452,284 HCV tests were performed. In March 2023, median test uptake was 62% (HIV), 57% (HBV) and 62% (HCV).

ED opt-out BBV testing identified 2002 people who were newly diagnosed (343 HIV, 1190 HBV, 484 HCV) and 473 who were previously diagnosed but not in care (HIV 209, HBV 156, HCV 108). Initial linkage to care was 339/552 (61%) for HIV (268/343 (78%) for new HIV diagnoses), 329/1346 (24%) for HBV and 292/592 (49%) for HCV.

Opt-out BBV testing in EDs has proven extremely effective for making new BBV diagnoses and re-engaging those previously diagnosed but not in care. We found unexpectedly high rates of HBV. Initial linkage to care is encouraging and is expected to increase over time.