Staff perspectives on implementing opt-out blood-borne virus testing in English emergency departments: a qualitative study
Staff perspectives on implementing opt-out blood-borne virus testing in English emergency departments: a qualitative study
BACKGROUND: A significant challenge to achieving global 2030 elimination goals for blood-borne viruses (BBVs) is identifying undiagnosed individuals and relinking those who are no longer in care. To address this, the UK government has implemented opt-out BBV testing in emergency departments (EDs) to increase access to BBV testing in high prevalence areas. All adult ED patients having a routine blood test are automatically tested for HIV, hepatitis B and C, unless they opt out. This study aimed to identify barriers and facilitators to the implementation of ED opt-out BBV testing and provide recommendations for future rollouts.
METHOD: Semi-structured interviews with 23 staff members across five ED sites in very high HIV prevalence areas were analysed thematically, informed by Normalisation Process Theory.
RESULTS: While there was some variation in staff knowledge and understanding of the programme, overall acceptance of the opt-out testing approach was found to be high. Training had a positive impact on staff understanding of the purpose of the intervention and the correct process, including the opt-out model. High workloads and competing priorities in EDs were significant barriers to testing. However, some specific systems and processes that facilitated the uptake of testing included automation and BBV champions. Giving the programme time to embed into practice and ensuring feedback loops and flexibility to 'tweak' the process was also essential to sustaining the programme.
CONCLUSION: To embed opt-out testing into emergency care, sites should implement automated test ordering, staff training, clear communication and dedicated champions, which can help to support earlier diagnosis, reduce inequalities and improve patient outcomes.
Allison, Siobhán
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May, Tom
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Roberts, Jonathan
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Hill-Tout, Rachel
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Hindle, Stephen
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Hickman, Matthew
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Yardley, Lucy
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Todd, Rachel
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Heath, Robyn
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Horwood, Jeremy
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Allison, Siobhán
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May, Tom
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Roberts, Jonathan
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Hill-Tout, Rachel
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Hindle, Stephen
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Hickman, Matthew
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Yardley, Lucy
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Todd, Rachel
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Heath, Robyn
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Horwood, Jeremy
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Allison, Siobhán, May, Tom, Roberts, Jonathan, Hill-Tout, Rachel, Hindle, Stephen, Hickman, Matthew, Yardley, Lucy, Todd, Rachel, Heath, Robyn and Horwood, Jeremy
(2026)
Staff perspectives on implementing opt-out blood-borne virus testing in English emergency departments: a qualitative study.
Emergency Medicine Journal.
(doi:10.1136/emermed-2025-215436).
Abstract
BACKGROUND: A significant challenge to achieving global 2030 elimination goals for blood-borne viruses (BBVs) is identifying undiagnosed individuals and relinking those who are no longer in care. To address this, the UK government has implemented opt-out BBV testing in emergency departments (EDs) to increase access to BBV testing in high prevalence areas. All adult ED patients having a routine blood test are automatically tested for HIV, hepatitis B and C, unless they opt out. This study aimed to identify barriers and facilitators to the implementation of ED opt-out BBV testing and provide recommendations for future rollouts.
METHOD: Semi-structured interviews with 23 staff members across five ED sites in very high HIV prevalence areas were analysed thematically, informed by Normalisation Process Theory.
RESULTS: While there was some variation in staff knowledge and understanding of the programme, overall acceptance of the opt-out testing approach was found to be high. Training had a positive impact on staff understanding of the purpose of the intervention and the correct process, including the opt-out model. High workloads and competing priorities in EDs were significant barriers to testing. However, some specific systems and processes that facilitated the uptake of testing included automation and BBV champions. Giving the programme time to embed into practice and ensuring feedback loops and flexibility to 'tweak' the process was also essential to sustaining the programme.
CONCLUSION: To embed opt-out testing into emergency care, sites should implement automated test ordering, staff training, clear communication and dedicated champions, which can help to support earlier diagnosis, reduce inequalities and improve patient outcomes.
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emermed-2025-215436.full
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Accepted/In Press date: 12 January 2026
e-pub ahead of print date: 3 February 2026
Identifiers
Local EPrints ID: 509236
URI: http://eprints.soton.ac.uk/id/eprint/509236
ISSN: 1472-0205
PURE UUID: 3f60fb89-3958-4f39-99bf-ee8367d50022
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Date deposited: 13 Feb 2026 17:54
Last modified: 14 Feb 2026 02:36
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Contributors
Author:
Siobhán Allison
Author:
Tom May
Author:
Jonathan Roberts
Author:
Rachel Hill-Tout
Author:
Stephen Hindle
Author:
Matthew Hickman
Author:
Rachel Todd
Author:
Robyn Heath
Author:
Jeremy Horwood
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