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 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 impacted positively on the staff’s understanding of the purpose of the intervention and the correct process, including the opt-out model. High workloads and competing priorities in EDs were a significant barriers to testing. However, there were specific systems and processes that facilitated the uptake of testing, these included automation and BBV champions. Giving the programme time to embed into practice and ensuring good feedback loops and flexibility to ‘tweak’ the process was 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.

RHT has received sponsorship from Gilead Sciences for presenting on ED opt-out BBV testing. JR has received sponsorship from VIV Health and Gilead Sciences for presenting on ED opt-out BBV testing. JH has received a grant from Gilead for another study. Gilead Sciences and VIV Health manufacture HIV and hepatitis medications but have not funded ED opt-out BBV testing. RHT, SH, and JR are all employed by the NHS, which has funded this project

This research was funded by NHS England and the National Institute for Health Research (NIHR), with support from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation (NIHR200877).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study obtained Oxford B Research Ethics Committee, HRA and HCRW ethical approval (IRAS PROJECT ID 327922/REC Reference 23/SC/0357)

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All data produced in the present study are available upon reasonable request to the authors