A ‘TOP POSTER’ presented at the European Association for the Study of the Liver (EASL) Congress 2025 has highlighted the significant impact of opt-out testing for blood-borne viruses (BBVs) in emergency departments (EDs) across London. In a city of 9.7 million people, with over 40% of residents born outside the UK, this initiative represents a major step toward the elimination of hepatitis B (HBV) and hepatitis C (HCV).
Since April 2022, NHS England has rolled out opportunistic, opt-out testing for HIV, HBV, and HCV in 34 EDs across areas with high HIV prevalence, with 28 sites based in London. Adults undergoing blood tests in these departments were automatically screened for HBV and HCV unless they declined. Test results were managed through hepatitis services, which also facilitated contact and linkage to care (LTC) for patients with new or unlinked positive results.
Over two years, the 28 London EDs recorded 3.3 million attendances, with 1.9 million individuals receiving blood tests. Of these, over 1.15 million were tested for both HBV and HCV, with uptake rates of 68% and 69%, respectively. HBV testing revealed 9115 HBsAg-positive results (0.77% positivity), with 48% being new diagnoses, 10% previously diagnosed but not in care, and 42% already engaged in care. LTC for HBV-positive cases stood at 57%.
For HCV, there were 11,831 positive antibody results (0.98%), but only 13% had active (RNA-positive) infections. Of the 1,289 RNA-positive individuals, 76% were new diagnoses, 9% previously diagnosed but not in care, and 8% already in care. LTC for new HCV diagnoses was higher, at 68%, though it dropped to 29% for those previously lost to care.
The study concludes that ED-based opt-out testing is both effective and acceptable; however, the variability in LTC rates underscores the need for improved clinical pathways, enhanced peer support, and targeted community engagement to ensure sustained progress toward hepatitis elimination.
Reference
Hill-Tout R et al. Emergency department opt out testing for HBV and HCV in London with integrated linkage to care: an effective initiative to diagnose hepatitis or work in progress?. Abstract TOP-015. EASL Congress, 7-10 May, 2025.
