New study highlights successes and challenges of England’s Emergency Departments opt-out testing for blood borne viruses
- 5th February 2026
A new study published in the Emergency Medicine Journal found strong overall support for opt-out Blood-Borne Viruses testing among Emergency Department staff, with training playing a crucial role in improving understanding of the programme’s purpose and processes. However, heavy workloads and competing priorities in busy Emergency Departments were identified as significant obstacles to testing.
Many people living with blood borne viruses (BBVs) such as HIV, hepatitis B, and hepatitis C are not diagnosed early, especially if they don’t visit traditional testing centres like sexual health clinics. Late diagnosis can lead to serious health problems and increase the risk of passing the virus to others. To help find people with BBVs earlier, NHS England began an opt-out testing programme in April 2022 in Emergency Departments in areas with high rates of HIV. This means all adult patients undergoing routine blood tests in Emergency Departments are automatically tested for BBVs unless they opt out. The approach is a key strategy to meeting the government’s goals to end new cases of HIV, hepatitis B, and hepatitis C by 2030.
To help improve the delivery of this new programme at testing sites, researchers at the NIHR Health Protection Research Unit in Evaluation and Behavioural Science examined the successes and challenges of its implementation among staff. This involved interviewing 23 staff members across five ED sites to understand how the programme is working in practice.
Key enablers for effective implementation
Staff described several factors that helped embed the programme into routine practice:
- Automated test ordering systems that reduce administrative burden.
- BBV “champions” within ED teams who promote the programme and support colleagues.
- Flexible processes and regular feedback loops that allow teams to refine workflows over time.
Based on the findings, the study developed key recommendations, which were shared with sites to improve delivery and support new sites in implementation. An animation was created to highlight the recommendations and support staff training.
Recommendations included:
- Implementation Planning: Build early connections between hospital management, ED teams, labs, HIV and Hepatitis services, IT, and clinical governance to streamline workflows. Use national and regional networks to share insights and best practices.
- Staff Engagement and Champions: Engage staff early with regular updates, testing figures, and case studies. Identify and support dedicated champions to maintain momentum and promote programme adoption.
- Staff Training: Provide practical, accessible training for all staff groups, covering programme aims, local processes, IT systems, care pathways, and stigma reduction. Include lived-experience stories to highlight real-world impact.
- Practical Delivery Solutions: Share proven strategies from existing sites, such as modified vials, visual prompts, and simple scripts, to overcome barriers and reinforce the opt-out process.
Continuous Feedback and Sustainability: Allow time for the programme to embed, maintain ongoing communication about progress and impact, and create opportunities for staff feedback to support long-term success.
What next?
The researchers will continue the evaluation through the wave 2 expansion to an additional 44 high HIV prevalence areas. This phase will include interviews with patients and community organisations to understand their views on opt-out ED testing and the linkage to care for people who are diagnosed with a BBV.
Siobhán Allison, lead author of the study, said:
“Finding and linking people who are not yet diagnosed to care is crucial for achieving elimination goals. Emergency Departments (EDs) are well positioned to reach individuals who might not have been tested for a BBV in other settings. Our study shows testing is highly acceptable among staff. Opt-out testing helps to normalise BBV testing and hopefully reduces stigma for people living with a BBV.”
Professor Jeremy Horwood, SexualHealth Improvement HIT co-director and project co-lead, said:
“Opt-out testing in Emergency Departments represents a vital opportunity to diagnose blood-borne viruses earlier and reduce health inequalities. Our findings show that opt-out testing is both feasible and widely supported by staff working in busy EDs. With the right training, clear processes and strong collaboration between teams, EDs can play a crucial role in identifying undiagnosed blood-borne viruses. As the programme expands, it will be important to build on these insights to ensure testing becomes fully embedded and sustainable across England.”
The study was funded by the National Institute for Health and Care Research (NIHR) and carried out by researchers from the NIHR Health Protection Research Unit in Evaluation and Behavioural Science at the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
