Introduction

In late 2022 BHIVA established a working group to develop a rapid guidance statement on the model of consent for opt-out testing for blood-borne viruses (BBVs; HIV, hepatitis B virus and hepatitis C virus) in emergency departments (EDs) and other acute medical settings. Routine opt-out HIV (with hepatitis B virus and syphilis) testing has been the standard of care in antenatal services since 2000 and a similar approach (testing for HIV with hepatitis B and hepatitis C viruses) has been successfully piloted in EDs in extremely high-prevalence areas across the UK over the past decade. The success of opt-out testing in EDs in finding new cases of HIV/BBVs and people who had been previously diagnosed but were no longer in care led to a commitment from the UK government to expand opt-out HIV/BBV testing to all EDs in the highest HIV prevalence areas, as part of the national HIV Action Plan. A further expansion of the scheme to over 40 other EDs in high-prevalence areas is currently planned. The rapid expansion of opt-out HIV testing in EDs has led to a pressing need for further guidance on opt-out testing to supplement the existing BHIVA/BASHH/BIA HIV testing guidelines.

This interim guidance is intended to assist EDs in high-prevalence (>2/1000) and extremely high- prevalence (>5/1000) areas, and other facilities managing people who present for urgent care (e.g. urgent treatment centres and same day emergency care), in developing processes for routine opt-out testing for BBVs including HIV and in reaching high coverage. It could also be used as a model for other healthcare settings. The guidance has been endorsed by the RCEM Quality in Emergency Care Committee. It is expected that an interim update to the BHIVA/BASHH/BIA HIV testing guidelines in 2024 will incorporate this guidance.

Given the successful experience of many EDs in using opt-out BBV testing, we propose a set of best practice recommendations for sites setting up similar testing processes. This guidance has been developed with a working group including ED consultants, HIV and Infectious Disease consultants and community representatives.

This guidance was published in February 2024 and will be reviewed in February 2025.

Downloads

BHIVA, BASHH, BIA and RCEM rapid guidance on opt-out blood-borne virus testing in high-prevalence and extremely high-prevalence acute medical settings and emergency departments

Consultation comments received by the BHIVA Secretariat during the public consultation process

Declaration of interests