A scoping review of the acceptability, feasibility and effectiveness of opt‐out blood‐borne virus (
BBV
) testing in secondary healthcare settings, in the
UK
Becky Metcalfe, Karen J. Maxwell, Kirsten Trayner, Max Wilkinson, Sharon Hutchinson, Claudia Estcourt, Alison J. Rodger Abstract
Background
Earlier diagnosis of blood‐borne viruses (BBVs)—HIV, hepatitis B (HBV) and hepatitis C (HCV)—remains a significant public‐health focus. Opt‐out testing in secondary healthcare settings can improve early diagnosis and linkage to care as part of BBV transmission elimination targets. This scoping review used APEASE criteria (acceptability, practicability, effectiveness, affordability, side‐effects and equity) to evaluate opt‐out BBV testing interventions in emergency departments (EDs) and medical assessment units (MAUs).
Methods
A systematic search of three databases was conducted for peer‐reviewed literature up to 30th June 2025. Inclusion criteria were: (a) opt‐out BBV testing intervention; (b) taking place within a secondary care setting; and (c) in the UK, Ireland, Australia and Canada. Data were extracted and analysed using APEASE criteria.
Results
Twenty‐eight studies met inclusion criteria. Opt‐out testing was acceptable to patients and healthcare professionals, particularly when supported by clear communication, staff training and leadership engagement. Practicability varied by setting; barriers included time constraints, unclear responsibilities and logistical challenges. Automation using electronic systems facilitated implementation. Effectiveness was demonstrated through increased testing uptake and case identification, especially in EDs. Minimal evidence exists on affordability and is likely to vary by population prevalence. No significant side effects (unintended outcomes) were reported, and universal testing was associated with reduced stigma. Opt‐out testing can improve access to testing for underserved populations, supporting its role in promoting health equity.
Conclusion
Opt‐out BBV testing in secondary care settings (EDs and MAUs) is a feasible, effective and equitable intervention when supported by appropriate infrastructure and resources. Efforts should focus on optimizing implementation strategies and extending opt‐out testing, including to lower‐prevalence settings.