Research and analysis

Public health evaluation of BBV opt-out testing in EDs in England: 24-month interim report

Updated 28 November 2024

Applies to England

Since April 2022, an opt-out bloodborne virus (BBV) testing in emergency departments (EDs) programme (hereafter referred to as ‘the Programme’) has rolled out across 34 EDs in England which were selected due to being in areas of very high diagnosed HIV prevalence.

This short interim report presents the public health evaluation findings from the start of the Programme in April 2022 until the end of March 2024. An accompanying slide set presenting the findings is also available.

A full evaluation of the Programme will be published after the 3-year programme has been completed.

Main messages

Testing

Over the first 24 months of the Programme, 1,981,590 HIV tests, 1,502,799 hepatitis C virus (HCV) tests and 1,185,678 hepatitis B virus (HBV) tests have been completed.

Overall, at the 16 sites where complete surveillance data was available, 60% of attendees had a blood test taken during their attendance and so were eligible to have a BBV test. Among those, 67% were tested for HIV, 62% were tested for HCV and 62% were tested for HBV.

Overall, of people tested, 73% had no record of a previous HIV test, 80% had no record of a past HCV test, and 76% had no record of a past HBV test in Sentinel Surveillance of Bloodborne Virus (SSBBV) data. The large proportions for each BBV suggest that the Programme is successful in reaching people who have likely not previously tested for all 3 BBVs.

New diagnoses

There were 1,957 new HBV diagnoses, 762 new HCV diagnoses (ribonucleic acid (RNA) positive) and 391 new HIV diagnoses across the 21 sites served by laboratories that report through the SSBBV system between April 2022 and March 2024, noting that new HIV diagnoses are only available to December 2023.

Women made up a higher proportion of people newly diagnosed with HIV or HCV through the Programme compared to people diagnosed with HIV or HCV in other settings. For all 3 BBVs, a higher proportion of people newly diagnosed by the Programme were aged 50 years and over compared to people diagnosed in other settings. New diagnoses of HCV and HBV for people living in the most deprived areas made up a higher proportion of new diagnoses compared to other settings.

For all 3 BBVs, a higher proportion of people of Black ethnicity were newly diagnosed by the Programme than people diagnosed in other settings. For HIV and HBV, the proportion of people newly diagnosed of Black African ethnicity was markedly higher than people diagnosed in other settings, and for HBV the proportion of people of White other ethnicity newly diagnosed was also higher. For HCV, the proportion of people of White other or Indian, Pakistani or Bangladeshi ethnicity that were newly diagnosed was markedly higher in the Programme than in other settings.

Linkage to care

The proportion of people newly diagnosed with HIV linked to care within 14 days has increased in the second year of the Programme (from 40% to 44%), as has the proportion of people previously diagnosed and relinked to care within 30 days (from 13% to 18%).

The proportion of people newly diagnosed with HCV linked to care within 28 days was 22% in the second year of the Programme, and the proportion of people previously diagnosed and relinked to care within 28 days was 23%. Although not directly comparable, this is an increase on the proportions reported at 12 months, where programmatic data was used as an indicator.

Although comparable linkage to care data is not available for HBV as no national HBV treatment and care surveillance is in place, the proportion of people newly diagnosed attending a hepatology clinic following their result increased in the second year of the Programme (according to programmatic data).

Introduction

Why bloodborne virus opt-out testing in EDs is important

The UK has committed to ending new HIV transmissions in England and has signed up to the World Health Organization (WHO) global health sector strategy on HIV, viral hepatitis and sexually transmitted infections to eliminate viral hepatitis as a public health threat by 2030. Multi-faceted testing strategies are needed to achieve this target.

ED opt-out testing is an inclusive approach and can address inequalities in testing among people who may not identify themselves as at risk of a BBV or experience barriers to accessing other health services. ED testing also offers an opportunity to re-engage people previously diagnosed who are not currently in BBV care.

The Programme and evaluation

In April 2022, implementation began of an NHS England (NHSE) funded programme (‘the Programme’) of opt-out testing for BBVs in EDs in areas of very high diagnosed HIV prevalence. The Programme provides testing for HIV, HBV and HCV for anyone aged 16 years and over (18 years and over at some sites) and having a routine blood test during their ED attendance, unless they opt out.

To understand the impact of the Programme and inform its potential roll out to other sites, NHSE commissioned the UK Health Security Agency (UKHSA) to conduct the following evaluations:

• a public health evaluation (undertaken by UKHSA)
• an implementation evaluation (undertaken by the University of Bristol)
• a budget impact assessment element of an economic evaluation (undertaken by the University of Bristol)

An interim report of findings from the public health and implementation evaluations at 12 months was published in November 2023.

This short interim report presents findings from the public health evaluation of the Programme at 24 months, with data up to the end of March 2024.

A full evaluation of the Programme will be published after the 3-year programme has been completed.

Flowchart of testing process for BBV opt-out testing in EDs

At the end of 24 months, all sites (34) were implementing HIV and HCV testing, and 30 had begun HBV testing, with HCV and HBV testing starting later at most sites. Under the opt-out approach, people attending EDs are informed about testing using accessible public-facing information including posters and banners produced in different languages appropriate for people attending EDs. Public facing information informs people about testing, its benefits, and how they can opt out or seek further information.

Figure 1. Flowchart of testing process for BBV opt-out testing in EDs

Aims and objectives of the public health evaluation

The primary aim of the 24-month interim evaluation is to provide a monitoring update on the Programme as it develops into its third year, from the go-live start dates for testing at each site for each BBV to the end of March 2024. A full evaluation of the Programme will be published after the 3-year programme has been completed.

Go-live dates: testing for each BBV sometimes started at different times within EDs. The go-live date is the date testing for the BBV started at an ED.

Objectives of the 24-month evaluation:

1. Explore the contribution of the Programme to newly diagnosing people with a BBV.
2. Explore the extent that testing in this setting reduces health inequalities in BBV testing.
3. Describe the effectiveness of the Programme in diagnosing and linking to care people who are newly diagnosed with a BBV, or previously diagnosed and not currently in care.
4. Describe the care pathway for individuals who are eligible for and tested for BBVs through the Programme.

Flowchart of coverage of data sources used in the public health evaluation

This evaluation uses data from several different data sources, which are described in the 12-month interim report. Testing and diagnosis data comes from SSBBV. This surveillance is sub-national and so data is not available for all participating sites. Of the 34 sites participating in the Programme 21 sites are included in SSBBV at 24 months, an, increase from 16 sites in the 12 months report. To understand test uptake, data from SSBBV is linked to data on ED attendances and those with blood tests in the Emergency Care Data Set (ECDS).

NHSE programme dashboard data is used to triangulate between data sources. For the linked data used for analysis of test uptake (SSBBV tests linked to ECDS attendances), 5 sites had lower numbers of tests compared to the NHSE programme dashboard, and so for the analysis of test uptake a restricted analysis of data from 16 sites was used (an increase from 5 sites in the 12 months report). NHSE programme dashboard data is also used to present overall numbers of completed tests undertaken by the Programme. Work is ongoing between UKHSA, NHSE and laboratories to improve coverage of SSBBV and understand and address data incompleteness and recording of ED testing data in SSBBV and ECDS surveillance data, to aid matching between datasets.

Figure 2. Flowchart of coverage of data sources used in the public health evaluation

Source: SSBBV testing is used for data on BBV testing and diagnoses.​ ECDS is used for data on ED attendances with blood tests.​

Testing

Programme scale: numbers of tests

In its first 2 years, the Programme was rolled out across 34 sites, which undertook a total of 4,670,067 tests, split as follows (Table 1).

Table 1. Number of tests completed in the Programme, by BBV (NHSE programme data)

Test	HIV	HCV	HBV
Number of tests completed	1,981,590	1,502,799	1,185,678

Proportion of ED attendances eligible for and completing a test in the Programme

Overall, at the 16 sites where complete surveillance data were available in SSBBV, on average 60% of attendees had a blood test on their attendance and so were eligible to have a BBV test. Among those, 67% were tested for HIV, 62% were tested for HCV and 62% were tested for HBV (Table 2). The proportion of eligible people tested varied, ranging at individual sites from 24% to 80% for HBV and HCV, and 24% to 85% for HIV.

Table 2. Proportion of eligible ED attendances completing a test in the Programme, by BBV (SSBBV data for 16 sites)

Test	HIV	HCV	HBV
Proportion of attendances eligible for BBV test	61%	59%	60%
Proportion of eligible attendance with a completed test	67% (range 24% to 85%)	62% (range 24% to 80%)	62% (range 24% to 80%)

Characteristics of people newly tested through the ED opt-out testing programme

To understand the impact of the Programme on reaching people who may not otherwise have been tested for a BBV, we looked at the characteristics of people tested through the Programme who did not have a record of a previous test for the same BBV in SSBBV.

Overall, 73% had no record of a previous HIV test, 80% had no record of a past HCV test, and 76% had no record of a past HBV test in SSBBV. For all 3 BBVs, the number of women who had no record of a past test was higher than for men.​ Coverage of SSBBV is not complete so it is possible that these people may have tested elsewhere, however the large proportions for each BBV suggest that the Programme is successful in reaching people who have likely not previously tested for all 3 BBVs.

New diagnoses

Overall numbers of new diagnoses, by BBV

Across the 21 sites served by laboratories that report through the SSBBV system, there were 1,957 new diagnoses of HBV, 762 new diagnoses of current HCV (HCV RNA positive) and 391 new diagnoses of HIV between April 2022 and March 2024, noting that HIV data is only available to December 2023 (based on the latest scheduled HIV surveillance submissions available). In addition, there were 519 people diagnosed with HCV who had previously been diagnosed and were not in care, and 314 people previously diagnosed with HIV and not in care.

It is likely that HIV new diagnoses from the Programme are underestimated in this report: see Appendix 3. Data limitations  section. It is likely that HIV new diagnoses from the Programme are underestimated in this report: see Appendix 3. Data limitations.

The highest number of new diagnoses was for HBV, reflecting the higher prevalence of people living with undiagnosed HBV compared to HCV and HIV.

There has been substantial effort and financial commitment nationally, regionally and locally to increase diagnosis and linkage to care and treatment for HIV and HCV in recent years, which needs to be replicated for HBV if the WHO elimination targets by 2030 are to be reached.

Characteristics of people with new HIV diagnoses, by setting

To understand the characteristics of people newly diagnosed with HIV through the Programme, we compared to data from the HIV and AIDS New Diagnosis Database (HANDD) which includes data on all new HIV diagnoses in England. For this comparison we selected from HANDD new diagnoses made during the same time frame and geographical region as the Programme, and excluded diagnoses made through the Programme. We found that:

• people who were newly diagnosed with HIV because of their ED attendance tended to be older than those newly diagnosed in other settings
• a greater proportion of women had a new HIV diagnosis through the Programme than in other settings
• people with White or Asian ethnicity made up a smaller proportion of those newly diagnosed through the Programme than in other settings, while people with Black African, Black Caribbean and Black other ethnicity made up a larger proportion
• a lower proportion of new HIV diagnoses through the Programme were among people living in the most deprived Index of Multiple Deprivation (IMD) quintile compared to people diagnosed in other settings

Figure 3. Characteristics of people with new HIV diagnoses, by setting, April 2022 to December 2023​

Source: ED opt-out testing data for 21 SSBBV sites, matched to HANDD or HIV and AIDS reporting system (HARS). Comparator data from HANDD, excluding data from ED opt-out testing sites, restricted to the same time frame and the regions in England where the Programme is being implemented.​

Data shows positive HIV test records identified through the Programme that are present within HANDD or HARS. Data does not include positive HIV test records which are unmatched with HANDD or HARS (approximately 7% of positive records; see Appendix 3. Data limitations for further information).

Characteristics of people with new HCV diagnoses, by setting

To understand the characteristics of people newly diagnosed with HCV and HBV through the Programme we compared to data from Second Generation Surveillance System (SGSS), which is the main system through which NHS diagnostic laboratories submit mandatory reports of notifiable organisms (which include HBV and HCV) to UKHSA. For this comparison we selected data from the same time frame and regions as the Programme and excluded data from the sites participating in the Programme, with no other restrictions being made. We found that:

• people who were newly diagnosed with a current HCV infection (HCV RNA positive) because of their ED attendance tended to be older than people newly diagnosed in other settings
• a greater proportion of women had a new HCV diagnosis in an ED than in other settings, with more men being diagnosed across all settings
• people with White British ethnicity made up a smaller proportion of those newly diagnosed in an ED than in other settings; White other, Indian, Pakistani and Bangladeshi, Black Caribbean and Black African and Asian ethnicity accounted for a larger proportion of new diagnoses in an ED
• a greater proportion of new HCV diagnoses through the Programme were among people living in the most deprived Index of Multiple Deprivation (IMD) quintiles compared to people diagnosed in other settings

Figure 4. Characteristics of people with new HCV diagnoses, by setting, April 2022 to March 2024​

Source: ED opt-out testing data for 21 SSBBV sites. Comparator data from SGSS, excluding data from ED opt-out testing sites, restricted to the same time frame and the regions in England where the Programme is being implemented.​

Characteristics of people with new HBV diagnoses, by setting

People who were newly diagnosed with HBV because of their ED attendance tended to be older than people newly diagnosed in other settings.

Proportions of new HBV diagnoses by sex characteristics were similar to those seen among people diagnosed in other settings. A greater proportion of new diagnoses are among men than women across all settings.

People with Black African, Black Caribbean, Black other and White other ethnicity made up a larger proportion of those newly diagnosed through the Programme than in other settings. White British ethnicity made up a smaller proportion of those newly diagnosed through the Programme than in other settings.

A greater proportion of new HBV diagnoses through the Programme were among people living in the most deprived IMD quintiles compared to people diagnosed in other settings.

Figure 5. Characteristics of people with new HBV diagnoses, by setting, April 2022 to March 2024​

Source: ED opt-out testing data for 21 SSBBV sites, other diagnoses use SGSS data excluding data from ED opt-out testing sites, restricted to the same time frame and the regions in England where the Programme is being implemented.

Routes of acquisition and social risk characteristics

Probable route of HIV acquisition, by setting

Compared to those diagnosed with HIV outside of ED, a higher proportion of people newly diagnosed through the Programme acquired their infection through sex between men and women and a lower proportion acquired their infection through sex between men.

Figure 6. Probable route of HIV acquisition, by setting, April 2022 to December 2023

Source: ED opt-out data for 21 SSBBV sites, matched to HANDD or HARS. Comparator data from HANDD, excluding data from ED opt-out testing sites, restricted to the same time frame and the regions in England where the Programme is being implemented. ​

Data show positive HIV test records identified through the Programme that are present within HANDD or HARS. Data does not include positive HIV test records which are unmatched with HANDD or HARS (see Appendix 3. Data limitations for further information). ​

Social risk characteristics for people newly diagnosed with HCV

Compared to people diagnosed with HCV RNA reported in national laboratory diagnoses surveillance (SGSS):

• a higher proportion (65%) of people with a new HCV diagnosis at an ED in the Programme had no known risk characteristics such as homelessness, a history of prison detention, being a person who injects drugs or not being registered with a general practitioner
• a lower proportion (around 35%) of people newly diagnosed at an ED in the Programme had one or more risk characteristic
• a lower proportion of people who were newly diagnosed with HCV through the Programme were identified as being people who inject drugs compared to other settings

This suggests that the ED programme is diagnosing people who may not be identified as at-risk and so are unlikely to be tested (and hence diagnosed) in other settings.

Figure 7. Social risk characteristics for people newly diagnosed with HCV, April 2022 to March 2024

Source: SSBBV matched to SGSS, and SGSS data excluding ED opt-out testing sites restricted to the same time frame.

Linkage to care

Linkage to care for people newly diagnosed with HIV or previously diagnosed and not currently in care

93% of people newly diagnosed with HIV in EDs during the Programme have been linked to care.

Linkage to care was lower among people previously diagnosed with HIV but not in care within the previous 15 months; 58% of people with a positive test were subsequently linked to care because of the Programme.

Figure 8. Linkage to care for people newly diagnosed with HIV or previously diagnosed and not currently in care, April 2022 to December 2023

Source: SSBBV matched to HANDD or HARS.

Timely linkage to care for people newly diagnosed with HIV

The proportion of people newly diagnosed with HIV and linked to care in a timely way (British HIV Association standards of care indicate people should be linked within 14 days of diagnosis) has increased in the second year of the Programme. The proportion linked within 14 days increased from 40% to 44%, and the proportion linked within 30 days increased from 58% to 63%.

These figures are lower than reported in national data, where 76% of people newly diagnosed with HIV were linked to care within 14 days in 2022.

Figure 9. Timely linkage to care for people newly diagnosed with HIV, April 2022 to December 2023

 

Source: SSBBV matched to HANDD or HARS. ​

Analysis is limited to diagnoses where enough time has passed to assess the completion of linkage to care within a given timeframe (for example, a person diagnosed within the last year of data would not be included in calculations of people linked to care within 1 year, as insufficient time has passed since their diagnosis).​

National data referred to is the HIV Action Plan monitoring and evaluation framework, 2023.

Time to re-engagement in care for people previously diagnosed with HIV

The proportion of people previously diagnosed with HIV and re-engaged in care within 30 and 90 days has increased in the second year of the Programme; the proportion of people re-engaged within 30 days increased from 13% to 18% and the proportion re-engaged within 90 days increased from 27% to 36%.

Figure 10. Time to re-engagement in care for people previously diagnosed with HIV​, April 2022 to December 2023

 

Source: SSBBV matched to HANDD or HARS. ​

​People are excluded from the follow-up period if they have not had enough time to be re-engaged. For example, a person tested in November 2023 will be excluded from both the 90 day and 1 year re-engagement figures due to the end of the December 2023 end of HIV data, and insufficient time passing since their ED test.​

Linkage to care for people newly diagnosed with HCV

Using SSBBV data from 21 sites linked to the NHSE Hepatitis C Patient Registry and Treatment Outcome System and NHSE Blueteq data on high-cost prescribing, 61% of those newly diagnosed with a positive HCV RNA test (620 people) through the Programme initiated HCV antiviral treatment with variation between sites ranging from 22% to 100%. People who died and those with no NHS number or other identifiers recorded to enable data linkage were excluded. This proportion includes those people referred for treatment that do not have a recorded treatment start date yet. Work is underway with all sites to better understand their site-level clinical data and how it is reflected in the proportion treated.

It is likely that the number of people recorded as initiating treatment will not reflect the number of people with whom contact has been made or who have been referred to care, as linked surveillance data does not capture activity to support all steps in the engagement process (see Data limitations: linkage to care for people diagnosed with HCV).

74% of people with a new HCV diagnosis through the Programme, and who were linked to treatment, had a treatment outcome reported. Of those, 72% had a sustained virologic response (SVR) (indicative of successful treatment with virus clearance) recorded or a recorded negative RNA test result at 98 days or more after treatment initiation.

A deep dive into new diagnoses at a single programme site in London found that:

• of those eligible (alive and resident within England), 75% were contactable and started treatment; including some patients with no fixed abode
• of the remaining 25% not contactable by any route, 3 out of 4 had no fixed abode and were referred to the Find and Treat team.

Figure 11. Linkage to care for people newly diagnosed with HCV​, April 2022 to March 2024 [Notes 1, 2 and 3]

Source: SSBBV linked to NHSE Hepatitis C Patient Registry and Treatment Outcome System and Blueteq.

Note 1: ‘Treatment outcome reported’ includes where an outcome has been reported on the NHSE Hepatitis C Patient Registry or an RNA test is available in SSBBV within 98 days after treatment initiation. Other treatment outcomes include relapse, breakthrough, lost to follow up, and non-response. Those who died between initiating treatment and receiving an outcome are included in the ‘Treatment started’ bar.

Note 2: This includes a clinical report of either an SVR through NHSE Hepatitis C Patient Registry or an RNA negative result at 98 days or more after treatment initiation. Individuals are excluded where a positive result has been recorded within 28 days of the RNA negative. ​

Note 3: ‘Referred to treatment but not initiated’ is likely to be an underestimation, based on surveillance data. This was calculated as records created in NHSE Hepatitis C Patient Registry or a multi-disciplinary team (MDT) undertaken for the individuals but no treatment start date recorded, or a received date is recorded in Blueteq without a treatment start date.

Linkage to care for people previously diagnosed with HCV

Of people with a positive HCV RNA test (477 people) through the Programme, who had a previous diagnosis of HCV but were not currently in care, 84% initiated treatment. People who died and those with no NHS number or other identifiers recorded to enable data linkage were excluded.

Of those people previously diagnosed and not in care that were linked to treatment, 78% of people had a treatment outcome reported. Of those, 63% had an SVR recorded or a recorded negative RNA test result at 98 days or more after treatment initiation.

Figure 12. Linkage to care for people previously diagnosed with HCV​, April 2022 to March 2024 [Notes 4, 5 and 6]

Source: SSBBV linked to NHSE Hepatitis C Patient Registry and Treatment Outcome System and Blueteq.

Note 4: ‘Treatment outcome reported’ includes where an outcome has been reported on the NHSE Hepatitis C Patient Registry or an RNA test is available in SSBBV within 98 days after treatment initiation. Other treatment outcomes include relapse, breakthrough, lost to follow up, and non-response. Those who died between initiating treatment and receiving an outcome are included in the ‘Treatment started’ bar.

Note 5: This includes a clinical report of either an SVR through NHSE Hepatitis C Patient Registry or an RNA negative result at 98 days or more after treatment initiation. Individuals are excluded where a positive result has been recorded within 28 days of the RNA negative. ​

Note 6: ‘Referred to treatment but not initiated’ is likely to be an underestimation, based on surveillance data. This was calculated as records created in NHSE Hepatitis C Patient Registry or an MDT undertaken for the individuals but no treatment start date recorded, or a received date is recorded in Blueteq without a treatment start date. ​

Data limitations: linkage to care for people diagnosed with HCV

The care pathway presented in this evaluation describes the steps from initiation of treatment through to SVR, following linkage to multiple surveillance datasets.

It is not possible to measure the proportion of individuals who were successfully contacted by services, at earlier or interim steps in the care pathway. While extensive efforts are made by the clinical team to contact and engage individuals in the care pathway, it is not possible to capture this in national surveillance data. For example, analysis from one programme site in London found that 91% of people who were HCV RNA screen positive (and 97% of people who were HBV screen positive) were contacted and notified by the hepatology team during the study period.

Surveillance datasets utilised in this evaluation do not capture some outcomes, such as clinical decisions where treatment is unsuitable (for example, patients on a palliative care pathway or people diagnosed while visiting the UK but reside in another country). As such, the number of people eligible for treatment according to this data is greater than the actual number of people who could be initiated on treatment, which will impact the proportions reported.

It is essential for records to have sufficient identifiers, including NHS number, to enable record linkage for monitoring through the care cascade. As there are patient records for people diagnosed with HCV that have no NHS number or other identifiers recorded (particularly among people newly diagnosed), it is likely that the number of patients included in ‘referred to treatment but not initiated’ counts will be an underestimate.

Data reported through the NHSE Hepatitis C Patient Registry and Treatment Outcome System is known to variably underreport treatment initiations in England. As a result, the proportion of people initiating treatment is expected to be an underestimate. Following the recommended action from the Hepatitis C in England 2023 report, this data has been triangulated with data from the NHSE Blueteq system, to provide an enhanced estimate of the proportion of people diagnosed who have initiated treatment. There are delays in recording on Blueteq, so some people may have started treatment but do not yet have this reflected in Blueteq.

Appendix 1. Methods

Further details of the data sources and methodology for the evaluation are available in the interim 12-month evaluation report.

The 24-month evaluation uses data from SSBBV, a voluntary sub-national surveillance system representing 21 out of 34 sites.

Further analysis was undertaken using data from 16 out of 21 sites, where there was more complete surveillance data for negative and positive tests to enable calculation of test uptake and positivity data.

A descriptive approach was taken to summarise BBV testing, positivity and referral to care for each virus, with counts and proportions provided.

Data was stratified by individual demographics including gender, age, ethnic group, IMD quintile and risk characteristic information.

For HIV new diagnoses, HANDD and HARS data is used to match to SSBBV positive HIV test records to confirm a diagnosis. As this data is only available to 31 December 2023, HIV analysis for the Programme is restricted up to this date.

For comparison with HIV diagnoses from outside of the Programme a geographical restriction on HANDD data was implemented, selecting diagnoses from city locations that are included within the Programme:

• Barnet
• Blackpool
• Brighton
• Carshalton
• Croydon
• Epsom
• Harrow
• Ilford
• Kingston upon Thames
• London
• Manchester
• Orpington
• Romford
• Salford
• Uxbridge.

HIV comparison data is for calendar years 2022 and 2023.

For comparison with HBV and HCV diagnoses made outside of the Programme a geographical restriction was implemented, selecting diagnoses from locations where the Programme is taking place in the following regions:

• South
• North West

HBV and HCV comparison data is for financial years 2022 to 2023 and 2023 to 2024.

Appendix 2. Data sources

The public health evaluation uses data from the following sources:

• National ECDS
• NHSE programme dashboard data on BBV opt-out testing in ED
• SSBBV testing in England
• SGSS
• HARS
• HANDD
• Arden and GEM NHSE Hepatitis C Patient Registry and Treatment Outcome System
• GUMCAD STI Surveillance System
• Hospital Episode Statistics
• NHSE Blueteq system to monitor prescribing of medicines

Blueteq is a web-based software system for the approval and management of high-cost medicines across a range of healthcare conditions.

For detailed definitions and explanations of each data source, please refer to the Data sources section of the 12-month interim evaluation report.

Appendix 3. Data limitations

Indicators on testing and diagnosis were feasible to produce from surveillance data for all 3 BBVs.

Surveillance data for BBV tests and diagnoses is sub-national and only covered some of the sites in the Programme, with 21 out of 34 sites having testing and diagnosis data.

Of those 21 sites, 16 had adequate comparable testing data when linked to ECDS to enable analysis of test uptake.

When comparing new diagnoses from the Programme with data from other settings, please note that data from EDs not participating in the Programme are included in ‘other settings’ and that no adjustment has been made for the demographics of the population of people attending ED sites.

Linkage to care for HBV cannot be monitored in surveillance data in a comparable way to HIV and HCV because there is currently no large-scale HBV treatment dataset available to monitor HBV care.

HIV data on new diagnoses does not include people who test positive but are not matched with HANDD or HARS data, for whom their linkage to care and setting of diagnosis is not known.

A significant proportion of positive HIV tests by the Programme could not be matched to HARS or HANDD due to missing identifiers fields (20%), preventing confirmation of a ‘new diagnosis’. It is therefore likely that HIV new diagnoses in this report are underestimated. However, based on other data we expect that only around 7% of those unmatched are likely to be new diagnoses.

Acknowledgements

Report produced by the Public Health and Implementation Evaluation Group of the ED Opt-out BBV Testing programme.

Our thanks go to Alison Brown, Ashley Brown, Olaide Adebayo-Clement, Tom Clare, Eloise Cross, Peter Dearman, Monica Desai, Tamara Đuretić, Beatrice Emmanouil, Mark Gillyon-Powell, Rachel Hill-Tout, Matthew Hibbert, Stephen Hindle, Susan Hopkins, Ian Jackson, David Leeman, James Lester, Kathy Lowndes, Sema Mandal, Veronique Martin, Priya Meghani, Debbie Mou, Sarah Murdoch, Specioza Nabiteeko, Simon Packer, Rakshita Parab, Celia Penman, Annabel Powell, Rajani Raghu, Rachel Roche, Victoria Schoemig, Ruth Simmons, Nicola Spencer, Georgia Threadgold.

We are grateful to all the NHS and non-NHS teams involved in managing and delivering the services and programmes outlined in this report, and in evaluating the Programme. We would like to acknowledge and thank the staff who work at each of the 34 programme sites and in the laboratories who contribute to the laboratory surveillance of each BBV and SSBBV.

The project was supported by National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, with a partnership between UKHSA and the University of Bristol. The views expressed are those of the author and not necessarily those of NIHR, Department of Health and Social Care, or UKHSA.

Suggested citation

ED BBV opt-out testing 24-month interim report 2024. October 2024. UKHSA, London.