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Opt-out HIV and hepatitis testing works – now we need the funding

3 min read

It’s not often you can present decision-makers with a sure-fire solution to a problem. One with real-world evidence that it not only works, but reduces inequalities, saves lives, and while saving money at the same time.

Sounds almost too good to be true, doesn’t it? Well opt-out HIV and hepatitis testing is exactly that – almost too good to be true. It’s proved to help us find thousands of people with undiagnosed HIV, hepatitis B and hepatitis C who would otherwise be unaware.

The clock is ticking. We have only a few years left to meet our national goals of eliminating new transmission of hepatitis C by 2025 and HIV by 2030. If we hope to end all new cases by then, we have to find everyone living with the conditions, and therefore not accessing wonderful modern treatments.

Relying on people thinking they may be at risk, and seeking out tests via sexual health services or through online platforms, has only got us so far, and rates of late diagnosis are going up, not down.

Over the last year, the NHS has been piloting a different approach and it’s worked. Opt-out testing has seen everyone who has their bloods taken in emergency departments across London, Manchester, Brighton and Blackpool, receive a test for HIV and hepatitis on an opt-out basis. In under a year, 1,700 people have been identified with HIV, hepatitis B or hepatitis C. It’s simply astonishing.  People who would have otherwise not been diagnosed and received treatment are now engaged in the health system. For those diagnosed with HIV, effective treatment will mean they won’t be able to pass the virus on to other people.

As this diagnosis means they can receive prompt treatment, improving lives and preventing them from getting seriously ill, opt-out testing saves money for the NHS. In the first 100 days of the programme launching in four cities, it saved an estimated a minimum of £6 - £8m in care costs.

It also addresses the deep and widening inequalities which have emerged, despite the country’s recent successes in HIV care and treatment. Opt-out testing reaches people who are disproportionately affected by higher rates of late diagnosis, including women and people from Black African communities. For example, 45% of people diagnosed with HIV in the first opt-out testing pilots were of Black African, Black Caribbean or Black ‘other’ ethnicity, which is more than twice as many as the nationwide average of 22% for these groups.

Despite clear evidence that opt-out testing saves lives, it is currently only offered in hospitals in four areas in England. Ahead of next week’s budget, we’ve delivered a letter alongside other charities including Terrence Higgins Trust, Elton John AIDS Foundation, British Liver Trust and Hepatitis C Trust to Public Health Minister Neil O’Brien and NHS England Chief Executive Amanda Pritchard calling on them to act now and fully fund the programme across the country.

There are over 30 more areas identified as having a high prevalence of HIV that are not currently able to offer opt-out testing due to a lack of national funding. If we have it in London, why not in Luton, Liverpool, Leicester or Leeds? We have it in Blackpool, but why should people in Bury, Bolton, Birmingham, Bournemouth and Bristol miss out?  If this government is truly committed to levelling up, they must invest in opt-out testing across the whole country, and ensure no-one is left behind.

Deborah Gold is chief executive of the National AIDS Trust.

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