The HIV Action Plan 2025 to 2030 aims to promote timely testing and reduce the number of people living with undiagnosed HIV
In England, an estimated 4,700 people are living with undiagnosed HIV. Testing is therefore a key pillar of the HIV Action Plan.
Testing in sexual health services rose 3% between 2023 and 2024. However, that progress that isn’t necessarily playing out across all demographics. Gay and bisexual men continue to have far higher rates of testing than heterosexual men and women, for example.
There are also variations by ethnicity. The HIV Action Plan monitoring and evaluation framework 2026 revealed just over two in five people (42%) diagnosed with HIV in 2024 received a late diagnosis – and Black African communities were disproportionately affected.
The HIV Action Plan aims to increase uptake of testing by expanding opt-out services in sexual health clinics, while broadening that work to a wider range of settings – including emergency departments, the NHS app and primary care.
Key takeaways for ICBs
- Emergency departments need support to deliver opt-out HIV testing
- The NHS app is due to pilot digital HIV testing by the end of 2026
- Primary care has been identified as a crucial setting for improving access
Opt-out testing in emergency departments
A core part of the drive to increase testing involves greater use of emergency departments (EDs). Hospitals in high-prevalence areas have already been piloting opt-out HIV testing in A&E, with encouraging results. So far, the work has diagnosed 719 new cases, half of which were late, and re-engaged 291 previously diagnosed individuals with their care.
NHS England also points to a UK Health Security Agency evaluation of the programme published in 2023, which found 62.8% of eligible attendees had no record of a previous blood borne virus (BBV) test. People tested through the programme were also older and more likely to be from an ethnic minority group than those testing outside the programme, it revealed.
On the back of those results, the HIV Action Plan has pledged to invest £108m in the delivery of opt-out testing in EDs in ‘very high and high HIV prevalence areas’ from April 2026 to March 2029. Opt-out testing has already been rolled out to nearly 90 EDs across England – in major cities such as London and Birmingham, but also in areas such as Grimsby, Poole, Hull, Worthing and Frimley. Progress will be monitored to ‘inform delivery and maximise efficient use of resources’ and the approach will be modified ‘as required to amplify impact’.
The expansion of the initiative is welcomed by Anne Aslett, CEO of the Elton John AIDS Foundation, who points to the uplift in testing among harder-to-reach populations. ‘It’s reaching older people, ethnic minority communities, heterosexual populations, people who would never have walked through the door of a sexual health clinic. That’s exactly the point.’
NHS England says ICBs have a clear role to play in supporting opt-out testing at EDs, by allocating funding efficiently. ‘ICBs ensure these monies are passed on to provider trusts promptly, working closely with local finance teams to avoid delays to delivery,’ says Rachel Hill-Tout, NHS England clinical lead for BBV opt-out testing in emergency departments.
‘Some ICBs directly commission HIV peer support services to support people identified with a BBV, others flow that funding to trusts or local councils,’ she adds. ‘Beyond funding flows, ICBs can support trusts through providing oversight of the additional operational pressures associated with implementation, providing coordination, problem‑solving and visibility at system level.’
NHS app testing
The HIV Action Plan wants to make testing ‘earlier, easier and more inclusive’. As part of that aim, it is looking to trial HIV home testing in the NHS App, in partnership with existing home test providers, by the end of 2026. That commitment has been backed by £5m in investment.
HIV home testing is already available through local sexual health websites. However, there is a ‘bit of a postcode lottery’ around who can access the free service, says Katie Clark, head of policy at the Terrence Higgins Trust. She is therefore pleased to see the commitment to a nationalised digital initiative.
‘We’re really excited about HIV home testing in the NHS app,’ she says. ‘It’s all part of the aim for the NHS app to be the front door of the NHS, and it means people can get tests in a much easier way than filling in a form on a website.’
There is also the added benefit of normalising the process. ‘Access to online HIV testing improves access to and acceptability of HIV testing and therefore helps to identify cases of undiagnosed HIV and prevent transmission,’ says a spokesperson from Derby and Derbyshire ICB, Lincolnshire ICB, and Nottingham and Nottinghamshire ICB cluster.
Primary care testing
Finally, primary care is emerging as a potential area for greater HIV testing. The HIV Action Plan set out plans to promote opt-out primary care HIV testing ‘in areas of very high and high HIV prevalence’ – to include people who have recently registered, and people who are having blood tests and have not had an HIV test in the last 12 months.
The potential benefits were made clear in the 2025 North Central London HIV GP Champions pilot, funded by Fast Track Cities London. By working directly with GPs, the programme aimed to deliver more proactive HIV care in a primary care setting.
As part of the initiative, GP champions promoted testing across a wider range of patients. ‘One of our aims was to increase testing in other areas and not just in sexual health clinics,’ says Dr Samantha Preston, a salaried GP at The Group Practice at River Place, Islington, and a GP champion at Fast Track Cities London. ‘People will attend testing in sexual health environments if they think they are at risk, but everyone goes to the GP.’
‘One example was, when we had annual reviews for people on the severe mental illness index, my team agreed to add in BBV screening,’ she reports. The initiative also involved routine testing in community gynaecology clinics, the addition of HIV testing into some cancer referral pathways, plus engagement with colposcopy services to encourage HIV testing for high-risk conditions.
The results are hammered home by Fast Track Cities London co-chair Professor Jane Anderson. ‘HIV testing in primary care shot up and hopefully that will be sustained, because it was being supported by people who are experts in primary care,’ she says. ‘Sooner or later, most people will go to a GP and if there is literacy and awareness there, then care will go up.’
Tristan Barber, chair of the British HIV Association (BHIVA), says clinicians are ‘often fearful of testing something they might think is stigmatising’. However, patient perceptions are very different. ‘When you ask patients who have had a blood test, they will assume they’ve been tested for HIV,’ he says. ‘There’s a disconnect.’
The clinical benefits of primary care testing are also acknowledged by the Royal College of GPs (RCGP). ‘Incorporating HIV testing into routine blood tests in higher prevalence areas, for example, could help normalise testing and increase timely diagnoses, provided this comes hand in hand with appropriate resources, clear guidance and patient consent,’ says RCGP president Professor Victoria Tzortziou Brown.
This report has been initiated and funded by MSD. MSD has had no input into the content of this non-promotional report.
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