A pilot project supported by the
Elton John AIDS Foundation has helped transform how HIV testing is offered in England, expanding a programme first introduced in two South London hospitals to 89 emergency departments across the country.
asserted
testing → support → country
The initiative makes HIV tests a routine part of emergency care, allowing patients to be tested unless they choose to decline.
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they → make → care
The approach aims to identify people who may be living with HIV without knowing it and connect them with treatment.
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who → aim → treatment
Its expansion follows evidence that routine testing can reach people who might otherwise miss opportunities for diagnosis and care.
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who → follow → diagnosis
How did the Elton John-backed pilot expand HIV testing across England
The Elton John AIDS Foundation began pioneering opt-out HIV testing in South London in 2018.
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Foundation → back → 2018
The initial work demonstrated how emergency departments could help identify people living with HIV who had not previously been diagnosed or who had become disconnected from treatment.
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who → demonstrate → treatment
According to the Foundation’s annual report, the pilot began in two South London hospitals and helped establish a model that could be extended across the NHS.
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that → accord → NHS
The programme has since been scaled up, with government funding supporting its expansion to 89 emergency departments across England.
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funding → scale → England
The Foundation’s report on pilot schemes to accelerate access to pre-exposure prophylaxis, commonly known as PrEP, also highlights the wider importance of identifying HIV infections early.
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report → accelerate → infections
The initiative has reportedly led to 1,000 new HIV diagnoses through the expanded testing programme, demonstrating the potential of emergency departments to reach people who may not otherwise seek an HIV test.
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who → lead → test
Why does opt-out testing make a difference
Under an opt-out approach, HIV testing is offered routinely as part of a patient's hospital care rather than relying entirely on individuals to request it.
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testing → opt → it
Patients can decline the test, but the default offer helps make testing a normal part of healthcare.
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testing → decline → healthcare
This matters because some people may not recognise their potential exposure to HIV or may feel uncomfortable asking for a test.
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people → matter → test
Others may avoid testing because of stigma or assumptions about who is likely to acquire the virus.
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who → avoid → virus
The Elton John AIDS Foundation explains that routine testing can help address these barriers by making the offer more inclusive.
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offer → explain → barriers
Its work has also shown the value of reaching people from communities that have historically faced inequalities in HIV testing and access to treatment.
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that → show → treatment
The Foundation’s HIV Social Impact Bond programme found that emergency departments and primary care settings were particularly effective in identifying Black African, Black Caribbean and Black Other women and girls living with HIV who might not have been tested elsewhere.
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who → find → HIV
What did the original South London programme achieve
The original initiative developed through a partnership involving the Elton John AIDS Foundation, Lambeth, Southwark and Lewisham councils, the National Lottery Community Fund, ViiV Healthcare, Comic Relief and Big Issue.
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initiative → achieve → Foundation
The Foundation’s account of its UK Social Impact Bond describes the programme as the world's first social impact bond focused on bringing people living with HIV into care.
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account → describe → care
It ran for 3 years, from 2018-21, across the 3 South London boroughs.
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It → run → boroughs
The programme combined HIV testing in hospital emergency departments, HIV clinics, GP surgeries and community settings.
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programme → combine → departments
Providers received payments based on results, including identifying people newly diagnosed with HIV and helping those who had stopped treatment return to care.
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who → receive → care
Over the three-year period, more than 265,000 people received HIV tests.
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people → receive → tests
More than 460 people living with HIV entered treatment, including people who received a new diagnosis and those who returned to care after previously stopping treatment.
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who → live → treatment
The Foundation estimated that the programme helped avoid £90 million in healthcare costs.
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programme → estimate → costs
Earlier diagnosis and timely treatment can reduce the likelihood of people becoming seriously ill, while helping prevent further HIV transmission.
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people → reduce → transmission
How has the programme influenced national HIV policy
The results of the South London project helped build the case for extending routine HIV testing beyond the original locations.
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results → influence → locations
According to the Foundation’s UK Social Impact Bond, evidence from the initiative informed the work of the HIV Commission, parliamentary inquiries into HIV testing and the impact of HIV on ethnic minority communities, and the development of the government’s HIV Action Plan.
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evidence → accord → Plan
In December 2021, the government announced £20 million in funding for emergency department HIV testing in areas with particularly high rates of new infections.
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government → announce → infections
This marked an important step towards making the approach available to more patients across England.
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approach → mark → England
The Foundation’s announcement on new funding to end HIV cases in England describes opt-out testing as a way to address inequalities in diagnosis and bring people into care earlier.
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announcement → end → care
The wider rollout also reflects the argument that HIV testing should not depend solely on whether someone visits a specialist sexual health service.
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someone → reflect → service
Why is prevention also central to the effort
Finding people who are already living with HIV is only one part of the effort to reduce new infections.
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who → find → infections
Prevention measures, including access to PrEP, are also important.
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measures → include → PrEP
PrEP is medication taken by HIV-negative people to reduce their risk of acquiring the virus.
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PrEP → take → virus
The Elton John AIDS Foundation states that it can reduce the risk of acquiring HIV through sex by around 99% when taken as prescribed.
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it → state → %
The Foundation’s pilot schemes initiative highlights the need to improve access to prevention alongside testing and treatment.
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initiative → highlight → testing
Its approach recognises that people need to know their HIV status, understand their prevention options and be able to obtain appropriate support without unnecessary barriers.
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people → recognise → barriers
The Foundation has also called for public health investment that can demonstrate long-term benefits.
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that → call → benefits
Preventing new infections and connecting people to treatment can reduce future pressure on health services, while helping individuals receive care before their condition worsens.
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condition → prevent → care
…and 5 more, not listed.
The Aporia
