Annual report from the sentinel surveillance of blood borne virus testing in England: data for January to December 2021
Published 7 March 2023
Applies to England
© Crown copyright 2023
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Background
This report provides summary data for individuals who had tests reported to the sentinel surveillance programme during 2021. The following sections 1 to 7 describe testing and demographic information for individuals tested by venepuncture and dried blood spot for hepatitis A to E, HIV, and HTLV.
The sentinel surveillance of blood borne virus testing began in 2002, with the aim of supplementing the routine surveillance of hepatitis. Information on the testing carried out in participating centres is collected irrespective of test result and can therefore be used as a basis for estimating diagnosed prevalence among those tested. This data has enhanced our knowledge and understanding of hepatitis testing, in terms of who is being tested and from which service types individuals are accessing testing, and in interpreting trends in the number of positive individuals identified over time. In 2021, sentinel surveillance captured front-line testing for hepatitis A, B, C and HIV, covering approximately 40% of the GP-registered population, and over 80% of the population from all 9 UK Health Security Agency (UKHSA) centre areas tested for hepatitis D, E and HTLV.
Laboratories participating in sentinel surveillance of blood borne virus testing during 2021 include: Abbott, Ashford, Birmingham, Brighton, Bristol, Cambridge, Chelsea and Westminster, Kings College, Eastbourne, Newcastle, St Georges, Grimsby, Homerton, Leeds, Liverpool, Manchester, Nottingham, Portsmouth and St Thomas. Data is also submitted from outreach testing services including Find and Treat, Hepatitis C Trust, and testing conducted by the operational delivery networks (ODNs) and submitted to the NHS England and NHS Improvement (NHS EI) testing database. We would like to thank all the laboratories who participate as the data they submit is fundamental to the work we do at UKHSA.
The number of tests for a year includes all tests for an individual until an individual is diagnosed positive – no tests are counted after a positive test – therefore an individual can be counted more than once. The proportion positive is calculated among individuals tested.
The supplementary tables referred to below are available, alongside this report.
1. Hepatitis A IgM testing
In 2021, 18 participating centres supplied hepatitis A-specific IgM antibody (anti-hepatitis A virus (HAV) IgM) testing data (a marker of acute infection). Overall 49,991 individuals were tested at least once for anti-HAV IgM, of whom 219 (0.44%) tested positive. The age and gender of individuals tested were well reported (>99% complete). Regional distribution can be found in Supplementary Table 1.
Males accounted for 53.5% of individuals tested, with a positivity of 0.42% for females and 0.37% for males. Among all individuals tested, the highest proportion of tests were among those aged 65 years and older (21.3%). The positivity was highest among 1 to 14 year olds (3.7%) (Supplementary Table 2). The median age of individuals tested was 51 years (interquartile range (IQR): 26 to 77) and was similar to the median age of individuals testing positive, which was 49 years (IQR: 24 to 72).
Service type was identified using the test location (table 1). Where the service type was known (50,811; 99.4%), the greatest proportion of individuals tested for anti-HAV IgM (42.5%) were in general practice, with a further 24.3% tested in other ward type (including cardiology, coroner, dermatology, haematology, ultrasound, x-ray), and 7.5% tested in general medical and surgical departments. Positivity was highest in individuals testing in paediatric services (1.5%), followed by accident and emergency services (1.2%).
Ethnicity for individuals tested for anti-HAV IgM was determined through linking to the hospital episode statistics (HES) using NHS number where available (Supplementary Table 3). Where known (32,067; 64.1%), 77.2% of individuals were of white or white British ethnic origin, a further 11.1% were of Asian or Asian British origin, 7.2% were black or black British origin and 4.5% were classified as being from a mixed or other ethnic background. The greatest proportion positive was among individuals of Asian or Asian British origin and black or black British (both 0.56%) and being from a mixed or other ethnic background (0.35%).
Table 1. Number of individuals tested, and testing positive, for anti-HAV IgM in participating centres by service type, January to December 2021*
| In primary care | Individuals tested | Number positive (%) |
|---|---|---|
| Accident and emergency | 3,468 | 43 (1.2) |
| Community outreach | 133 | 0 (0.0) |
| Drug dependency services | 55 | 0 (0.0) |
| General practitioner | 21,614 | 50 (0.2) |
| Occupational health | 32 | 0 (0.0) |
| Prison services | 57 | 0 (0.0) |
| Sexual health services | 2,359 | 2 (0.08) |
| Total primary care§ | 27,661 | 95 (0.3) |
| In secondary care | Individuals tested | Number positive (%) |
| Antenatal | 608 | 2 (0.3) |
| Fertility | 106 | 0 (0.0) |
| General medical/surgical departments | 3,823 | 18 (0.5) |
| Obstetrics and gynaecology | 960 | 0 (0.0) |
| Other ward type (known service)† | 12,368 | 41 (0.3) |
| Paediatric services | 1,217 | 18 (1.5) |
| Renal | 633 | 5 (0.8) |
| Specialist HIV services | 90 | 0 (0.0) |
| Specialist liver service | 1,912 | 6 (0.3) |
| Unspecified ward¥ | 1,376 | 9 (0.7) |
| Total secondary care§ | 22,653 | 99 (0.4) |
| Unknown¥¥ | 307 | 25 (8.1) |
*Excludes reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial. All data is provisional. An individual can test in more than one service type.
§Totals for individuals testing in primary and secondary care do not equal the sum of the individuals testing in each setting as an individual can test in more than one setting.
†Other ward type includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray.
¥These are hospital services which are currently being investigated to identify specific service type, and may include any of the secondary care services mentioned above.
¥¥These services are currently being investigated to identify the specific service type, where possible.
2. Hepatitis B surface antigen testing
Sentinel surveillance collects data on testing for hepatitis B surface antigen (HBsAg) indicative of current hepatitis B infection. All pregnant women in the UK are offered hepatitis B virus (HBV) screening as part of their antenatal care. Data from the test request location and free text clinical details field accompanying the test request was reviewed to distinguish individuals tested for HBsAg as part of routine antenatal screening (section 2.1) from those tested in other settings and for other reasons (section 2.2). It is possible that some women undergoing antenatal screening may not be identified as such and may therefore be included in section 2.2 as non-antenatal testing.
2.1 Antenatal HBsAg screening
In 2021, 131,533 women aged between 12 and 49 years old were identified as undergoing at least one antenatal screening for HBsAg, representing 23.8% of all individuals tested for HBsAg (552,212) in participating sentinel centres. Overall, 261 (0.2%) of these women tested positive. The median age of women tested was 31 years (IQR: 27 to 35) and the median age of women testing positive was 32 years (IQR: 28 to 36). The regional distribution can be found in Supplementary Table 4. An HBeAg result was available for 86.2% (226) of HBsAg-positive women and, of these, 8.4% (19) were HBeAg positive, indicative of viral replication.
Most women who underwent antenatal screening were classified as belonging to one of four broad ethnic groups (n= 88,807; 67.5%) (table 2). Where known, the majority of individuals were classified as being of white or white British ethnic origin (75.1%), a further 12.6% were classified as Asian or Asian British origin, 7.0% were classified as black or black British origin, and 5.3% as being from a mixed or other ethnic background. The proportion testing positive was higher among women of black or black British origin (0.3%), followed by women from a mixed or other ethnic background (0.2%), women of Asian or Asian British origin (0.1%) and women of white or white or white British origin (0.07%). Among women testing for HBeAg, 14.3% of women classified as Asian or Asian British were HBeAg positive, and 3.0% of white or white British women were HBeAg positive (table 2).
Table 2. Number of antenatal women (12 to 49 years) tested and testing positive for HBsAg, and number of HBsAg positive women tested and testing positive for HBeAg by ethnic group, January to December 2021*
| Ethnic group | Number HBsAg tested | Number HBsAg positive (%) | Number tested for HBeAg (%) | Number HBeAg positive (%) |
|---|---|---|---|---|
| Asian or Asian British ethnic background | 11,166 | 16 (0.1) | 14 (87.5) | 2 (14.3) |
| Black or black British ethnic background | 6,195 | 20 (0.3) | 16 (80.0) | 0 (0.0) |
| Mixed or other ethnic background | 4,744 | 11 (0.2) | 7 (63.6) | 0 (0.0) |
| White or white British ethnic background | 66,702 | 47 (0.1) | 33 (70.2) | 1 (3.0) |
| Unknown ethnic background | 42,726 | 167 (0.4) | 156 (93.4) | 16 (10.3) |
*Excludes dried blood spot testing, oral fluid testing, reference testing and testing from hospitals referring all samples. Only women aged 12 to 49 years are included. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional.
2.2 Non-antenatal HBsAg testing
In 2021, 512,505 samples were tested for HBsAg, excluding antenatal screening, in 22 participating sentinel centres, equating to 423,921 individuals. Overall, 4,168 (1.0%) individuals tested HBsAg positive. Regional distributions can be found in Supplementary Table 5.
The age and gender of individuals tested for HBsAg were well reported (>98% complete). Where known, (417,152) 51.6% of individuals testing were male (Supplementary Table 6). The number of females tested may include some undergoing routine antenatal screening who could not be identified as such from the information provided. Positivity was higher among males compared to females (1.2% vs 0.7% p<0.001). Among all individuals testing, the highest proportion of tests (24.6%) were among those aged between 25 and 34 years, followed by those aged between 35 and 44 years (22.3%). The highest positivity was among those aged between 35 and 44 years, and 45 and 54 years (both 1.3%). The median age of individuals tested was 40 years (IQR: 30 to 56) and testing positive was 40 years (IQR: 32 to 49).
Where known (440,343; 99.5%), the greatest proportion of individuals tested for HBsAg were tested in the other ward type (includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray) (25.2%), with a further 23.5% tested in general practice and 8.1% tested in drug dependency services (table 3). Positivity was highest among individuals testing in community and outreach service, drug dependency service and specialist liver services (1.9%, 1.5% and 1.4% respectively).
Table 3. Number of tests, and individuals tested and testing positive, for HBsAg in participating centres by service type (excluding antenatal testing), January to December 2021*
| In primary care | Number of tests | Number of individuals tested | Number positive (%) |
|---|---|---|---|
| Accident and emergency | 13,095 | 12,697 | 116 (0.9) |
| Community outreach | 340 | 323 | 6 (1.9) |
| Drug dependency services | 37,345 | 35,815 | 540 (1.5) |
| General practitioner | 106,780 | 103,528 | 985 (1.0) |
| Occupational health | 19,830 | 19,233 | 86 (0.4) |
| Pharmacyβ | – | – | – |
| Prison services | 28,346 | 24,135 | 250 (1.0) |
| Sexual health services | 34,812 | 31,223 | 369 (1.2) |
| Total primary care§ | 240,557 | 225,758 | 2,352 (1.0) |
| In secondary care | Number of tests | Number of individuals tested | Number positive (%) |
| Fertility services | 15,573 | 14,351 | 34 (0.2) |
| General medical/surgical departments | 15,780 | 14,501 | 58 (0.4) |
| Obstetrics and gynaecology | 21,450 | 18,929 | 52 (0.3) |
| Other ward type (known service)† | 124,186 | 111,026 | 1,105 (1.0) |
| Paediatric services | 6,006 | 5,519 | 34 (0.6) |
| Renal | 55,213 | 21,056 | 113 (0.5) |
| Specialist HIV services | 1,162 | 1,106 | 12 (1.1) |
| Specialist liver service | 13,107 | 12,182 | 168 (1.4) |
| Unspecified ward¥ | 17,311 | 14,710 | 185 (1.3) |
| Total secondary care§ | 270,168 | 203,669 | 1,761 (0.9) |
| Unknown¥¥ | 2,152 | 2,056 | 55 (3.2) |
*Excludes oral fluid, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. An individual can test in more than one service type. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
βData for pharmacy testing is not presented due to low numbers.
§Totals for individuals testing in primary and secondary care do not equal the sum of the individuals testing in each setting as an individual can test in more than one setting.
†Other ward type includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray.
¥These are hospital services which are currently being investigated to identify specific service type, and may include any of the secondary care services mentioned above.
¥¥These services are currently being investigated to identify the specific service type, where possible.
Of the individuals tested for HBsAg, where ethnicity was known (52.7%, 223,396) the majority of individuals were of white or white British ethnic bakground (72.7%), a further 12.1% were of Asian or Asian British background, 10.2% were of black or black British background and 5.0% were of mixed or other ethnic background. The proportion positive varied by ethnic group; 1.9% among individuals of mixed or other ethnic background tested positive followed by 1.6% among individuals of black or black British background, 1.0% among individuals of Asian or Asian British background and 0.4% among individuals of white or white British background.
Table 4. Number of tests, individuals tested and individuals testing positive for HBsAg in participating centres by ethnic group (excluding antenatal testing), January to December*
| Ethnic group | Number of tests | Number of individuals tested | Number HBsAg positive (%) |
|---|---|---|---|
| Asian or Asian British ethnic background | 36,211 | 27,084 | 269 (1.0) |
| Black or black British ethnic background | 33,969 | 22,729 | 361 (1.6) |
| Mixed or other ethnic background | 13,668 | 11,080 | 209 (1.9) |
| White or white British ethnic background | 208,308 | 162,503 | 647 (0.4) |
| Unknown ethnic background | 220,349 | 200,525 | 2,682 (1.3) |
*Excludes dried blood spot, oral fluid, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
3. Hepatitis C antibody testing
Sentinel surveillance collects data on testing for hepatitis C-specific antibodies (anti-HCV), a marker of ever having a hepatitis C (HCV) infection. Positive anti-HCV results do not necessarily represent incident or current infections, with a HCV polymerase chain reaction (PCR) test required to identify a current infection.
In 2021, 518,409 samples were tested for anti-HCV in 23 participating sentinel centres, equating to 434,276 individuals. Overall, 13,187 (3.0%) individuals tested positive. This varied by Pre-Hospital Emergency Care (PHEC) and ODN (Supplementary Table 8).
Of those individuals testing positive for anti-HCV (13,187), 12,165 (92.2%) were tested for HCV RNA on the same day or after their anti-HCV positive test. Among those tested for HCV RNA after a positive anti-HCV test, 36% (4,381) were positive, of whom 5% (n=219) had an HCV genotype recorded; 40.6% were genotype 1, and 47.9% genotype 3, with a further (0.5%) had both genotype 1 and 3.
Age and gender were well reported (>98% complete). Where known (428,623), 54.6% of individuals testing were male, with a higher positivity in males compared to females (3.9% vs 1.9% respectively, p<0.001). Where known (434,463), the highest proportion of tests (24.2%) were among those aged between 25 and 34 years, followed by those aged between 35 and 44 years (22.3%). The highest positivity was among those aged between 45 and 54 years with 5.6%, followed by those aged 35 to 44 years (5.0%) (Supplementary Table 9). The median age of those tested was 40 years (IQR: 31 to 56 years), whereas the median age of those tested positive was 43 years (IQR: 37 to 51 years).
Where known (449,539; 99.6%), the greatest proportion of individuals tested for anti-HCV were from the other ward type (includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray) (24.6%), with a further 20.4% from general practice and 9.4% from sexual health sevices (table 5). The highest positivity was among individuals testing in specialist drug services (24.5%), Community and outreach (17.9%) and pharmacies (11.1%)
Table 5. Number of tests, and individuals tested and testing positive, for anti-HCV in participating centres by service type, January to December 2021*
| In primary care | Number of tests | Number of individuals tested | Number positive (%) |
|---|---|---|---|
| Accident and emergency | 20,626 | 19,990 | 207 (1.0) |
| Community outreach | 1,917 | 1,897 | 340 (17.9) |
| Drug dependency services | 34,121 | 33,382 | 8,162 (24.5) |
| General practitioner | 94,774 | 91,686 | 1,050 (1.1) |
| Pharmacyβ | – | – | – |
| Occupational health | 19,376 | 18,334 | 46 (0.3) |
| Prison services | 27,483 | 23,716 | 816 (3.4) |
| Sexual health services | 54,379 | 42,386 | 337 (0.8) |
| Total primary care§ | 252,685 | 230,121 | 10,959 (4.8) |
| In secondary care | Number of tests | Number of individuals tested | Number positive (%) |
| Antenatal | 10,257 | 10,063 | 24 (0.2) |
| Fertility services | 15,579 | 14,365 | 10 (0.07) |
| General medical/surgical departments | 16,048 | 14,851 | 116 (0.8) |
| Obstetrics and gynaecology | 13,197 | 11,989 | 26 (0.2) |
| Other ward type (known service)† | 122,854 | 110,788 | 916 (0.8) |
| Paediatric services | 5,960 | 5,531 | 20 (0.4) |
| Renal | 47,534 | 20,639 | 64 (0.3) |
| Specialist HIV services | 4,290 | 3,934 | 74 (1.9) |
| Specialist liver service | 12,612 | 11,719 | 254 (2.2) |
| Unspecified ward¥ | 15,560 | 14,260 | 381 (2.7) |
| Total secondary care§ | 263,891 | 209,316 | 1,885 (0.9) |
| Unknown¥¥ | 1,833 | 1,782 | 343 (19.2) |
*Excludes oral fluid, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. An individual can test in more than one service type. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
βData for pharmacy testing is not presented due to low numbers.
§Totals for individuals testing in primary and secondary care do not equal the sum of the individuals testing in each setting as an individual can test in more than one setting.
†Other ward type includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray.
¥These are hospital services which are currently being investigated to identify specific service type, and may include any of the secondary care services mentioned above.
¥¥These services are currently being investigated to identify the specific service type, where possible.
Of the individuals tested for anti-HCV, where ethnicity was known (206,157; 47.5%), the majority of individuals were of white or white British ethnic background (71.4%), a further 12.8% were of Asian or Asian British background, 10.8% were of black or black British background and 5.0% were of mixed or other ethnic background. The proportion positive varied slightly by ethnic group: 2.0% among individuals of white or white British ethnic background, 1.0% among individuals of mixed or other ethnic background, 0.6% among individuals of Asian or Asian British ethnic background, 0.3% in black or black British ethnic background.
Table 6. Number of tests, individuals tested and individuals testing positive for anti-HCV in participating centres by ethnic group, January to December 2021*
| Ethnic group | Number of tests | Number of individuals tested | Number anti-HCV positive n (%) |
|---|---|---|---|
| Asian or Asian British ethnic background | 33,253 | 26,344 | 166 (0.6) |
| Black or black British ethnic background | 30,323 | 22,307 | 72 (0.3) |
| Mixed or other ethnic background | 12,344 | 10,276 | 99 (1.0) |
| White or white British ethnic background | 184,526 | 147,230 | 2,989 (2.0) |
| Unknown ethnic background | 257,963 | 228,119 | 9,861 (4.3) |
*Excludes dried blood spot testing, oral fluid testing, reference testing and testing from hospitals referring all samples. Excludes individuals aged less than one year – in whom positive tests may reflect the presence of passively-acquired maternal antibody rather than true infection. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
4. Hepatitis D total antibody testing
Sentinel surveillance collects data on testing for hepatitis D-specific total antibody (HDV TA) and IgM antibody (anti-HDV IgM), a marker of acute hepatitis D (HDV) infection among those positive for hepatitis B. Seven sentinel laboratories provide HDV testing facilities: Ashford, Colindale, Eastbourne, Grimsby, Homerton, Leeds and Portsmouth. Given the small number of tests, individuals tested for HDV TA and/or HDV IgM are aggregated, and therefore do not necessarily represent incident infections.
In 2021, 3,070 individuals were tested at least once for HDV TA and/or HDV IgM, and 127 (4.1%) individuals tested positive. Regional distributions are found in Supplementary Table 10.
The age and gender of individuals tested for HDV were well reported (>98% complete). Where known (3,032), 54.9% of individuals testing were male, whereas the positivity was higher among females than males (4.5% and 3.8% respectively, p=0.205). The highest proportion of tests were among those aged between 35 and 44 years (30.6%), followed by those aged between 25 and 34 years (26.4%). Positivity was highest among those aged between 45 and 54 years (6.3%), followed by those aged between 35 and 44 (4.1%) and 25 and 34 years (3.7%). The median age of individuals tested was 39 years (IQR: 33 to 39) and the median age of individuals testing positive was 40 years (IQR: 34 to 49).
Where known (3,123; 100%), the greatest proportion of individuals (57.9%) were tested by a hospital which referred all HDV samples to a sentinel centre. In these cases, the service that originally requested the test could not be determined. A further 21.8% tested in other known hospital wards, and 7.8% tested in general practice.
Of the individuals tested for hepatitis D, where ethnicity was known (1,548; 50.4%) (Supplementary Table 11), 35.7% were of white or white British ethnic background, a further 28.7% were of black or black British ethnic background, 18.8% were of Asian or Asian British ethnic background, and 16.7% were of mixed or other ethnic background. The proportion positive varied by ethnic group; 4.7% among individuals of white or white British ethnic background tested positive, 4.1% among individuals of Asian or Asian British ethnic background, 3.4% among individuals of black or black British ethnic background and 1.5% among individuals of mixed or other ethnic background.
5. Hepatitis E IgM testing
Sentinel surveillance collects data on testing for hepatitis E-specific IgM antibody (anti-HEV IgM), a marker of acute hepatitis E (HEV) infection. Eleven sentinel laboratories provide HEV testing facilities: Ashford, Birmingham, Cambridge, Colindale, Chelsea and Westminster, Eastbourne, Newcastle, Grimsby, Homerton, Leeds, and Nottingham.
In 2021, 24,164 individuals were tested at least once for anti-HEV IgM. Overall, 705 (2.9%) individuals tested positive. The age and gender of individuals tested for anti-HEV IgM were well reported (>99% complete). Where known (24,059), 52.4% of individuals testing were male, with a higher positivity among males compared to females (3.3% vs. 2.3% respectively, p<0.001). The highest proportion of tests were among those aged 65 years and older (27.0%), followed by those aged between 55 and 64 years (17.1%). Positivity was also highest in those aged 65 years and older and those 55 and 64 years (4.2% and 3.8% respectively). The median age of individuals tested was 51 years (IQR: 35 to 66) and the median age of individuals testing positive was 61 years (IQR: 49 to 70).
Overall, 4.7% (317 out of 6,695) of males aged 50 or over tested for anti-HEV IgM were positive, compared to 1.6% (94 out of 5,903) among those under the age of 50. A similar pattern was seen among females, where 3.0 % (181 out of 6,076) of females aged 50 or over tested positive compared to 1.4% (77 out of 5,372) among those under the age of 50.
Where known (24,399; 99.6%), the greatest proportion of individuals (40.8%) were tested by a hospital which referred all HEV samples to a sentinel centre. In these cases, the service that originally requested the test could not be determined. A further 16.6 % tested in other known hospital wards, and 13.7% tested by a general practitioner.
Of the individuals tested for hepatitis D, where ethnicity was known (16,887; 69.9%) (Supplementary Table 13), the majority of individuals were of white or white British ethnic background (79.0%), a further 12.5% were of Asian or Asian British ethnic background, 3.5% were of mixed or other ethnic background, and 5.0% were of black or black British ethnic background. The proportion positive varied by ethnic group; 3.6% individuals of white or white British ethnic background tested positive, compared to 2.2% positivity in individuals of mixed or other ethnic background, 1.5% of Asian or Asian British ethnic background and 1.0 % of black or black British ethnic background.
6. HIV testing
Sentinel surveillance collects data on testing for HIV. All pregnant women in the UK are offered HIV screening as part of their antenatal care. Data from the test request location and the free-text clinical details field accompanying the test request was reviewed to distinguish individuals tested for HIV as part of routine antenatal screening (section 6.1) from those tested in other settings and for other reasons (section 6.2). It is possible that some women undergoing antenatal screening may not be identified as such and may therefore be included in section 6.2 as non-antenatal testing.
6.1 Antenatal HIV screening
In 2021, 112,442 women aged between 16 and 49 years old were identified as undergoing antenatal screening at least once for HIV, representing 17.0 % of all individuals tested for HIV in participating sentinel centres. Overall, 52 (0.05%) of these women tested positive. Regional distributions can be found in Supplementary Table 14. The median age of women tested was 31 years (IQR: 27 to 35) and the median age of women testing positive was 33 years (IQR: 29 to 36).
6.2 Non-antenatal HIV screening
In 2021, 653,594 samples were tested for HIV, excluding antenatal screening, in 20 participating sentinel centres, equating to 554,284 individuals (adults aged 16 years and over). Overall, 2,986 (0.5%) individuals tested positive, with regional distribution found in Supplementary Table 15.
The age and gender of adults tested for HIV were well reported (>99% complete). Where known (550,229), 53.1% of individuals testing were female (Supplementary Table 16). The number of females tested may include some undergoing routine antenatal screening who could not be identified as such from the information provided. Positivity was higher in males compared to females (0.9% vs 0.2% respectively, p<0.001). Of individuals tested, 29.0% were aged between 25 and 34 years followed by 20.4% aged between 35 and 44 years. Positivity was highest in those aged between 45 and 54 years (1.0%), followed by those aged between 55 and 64 years (0.8%), and 35 and 44 years (0.7%). The median age of individuals tested was 37 years (IQR: 28 to 52) and the median age of individuals testing positive was 42 years (IQR: 33 to 52).
Where known (n=576,371; 99.6%), the greatest proportion of individuals tested for HIV were from sexual health services (19.2%), with a further 18.5% tested in other ward type and 18.2% tested in accident and emergency (table 7). The highest positivity was among individuals tested in specialist HIV services (5.7%), followed by specialist liver services (1.0%) and sexual health services (0.9%).
Table 7. Number of adults (16+ years old) tested and testing positive for HIV in participating centres by service type (excluding antenatal testing), January to December 2021*
| In primary care | Number of tests | Number of individuals tested | Number positive (%) |
|---|---|---|---|
| Accident and emergency | 120,418 | 105,111 | 652 (0.6) |
| Community outreach | 1,199 | 1,070 | 5 (0.5) |
| Drug dependency services | 13,393 | 13,185 | 16 (0.1) |
| General practitioner | 97,162 | 93,643 | 221 (0.2) |
| Occupational health | 17,543 | 16,877 | 21 (0.1) |
| Pharmacyβ | – | – | – |
| Prison services | 12,706 | 11,285 | 31 (0.3) |
| Sexual health services | 133,918 | 110,828 | 1,041 (0.9) |
| Total primary care§ | 396,345 | 346,220 | 1,987 |
| In secondary care | Number of tests | Number of individuals tested | Number positive (%) |
| Fertility services | 22,756 | 20,402 | 31 (0.2) |
| General medical/surgical departments | 16,301 | 15,235 | 51 (0.3) |
| Obstetrics and gynaecology | 24,421 | 23,073 | 22 (0.1) |
| Other ward type (known service)† | 116,537 | 106,510 | 402 (0.4) |
| Paediatric services | 3,296 | 3,201 | 6 (0.2) |
| Renal | 28,323 | 16,099 | 38 (0.2) |
| Specialist HIV services | 3,152 | 3,132 | 178 (5.7) |
| Specialist liver service | 9,720 | 9,008 | 94 (1.0) |
| Unspecified ward¥ | 30,549 | 27,704 | 143 (0.5) |
| Total secondary care§ | 255,410 | 217,112 | 965 (0.4) |
| Unknown¥¥ | 2,193 | 2,125 | 34 (1.6) |
*Excludes oral fluid, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. An individual can test in more than one service type. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
βData for pharmacy testing is not presented due to low numbers.
§Totals for individuals testing in primary and secondary care do not equal the sum of the individuals testing in each setting as an individual can test in more than one setting.
†Other ward type includes cardiology, coroner, dermatology, haematology, ultrasound, x-ray.
¥These are hospital services which are currently being investigated to identify specific service type, and may include any of the secondary care services mentioned above.
¥¥These services are currently being investigated to identify the specific service type, where possible.
Of the individuals tested for HIV, where ethnicity was known (n=223,717; 40.4%) (table 8), the majority of individuals were of white or white British ethnic background (69.3%), a further 9.6% were of Asian or Asian British ethnic background, 17.2% were of black or black British ethnic background and 3.8% were of mixed or other ethnic background. Most individuals of unknown ethnic origin were tested in sexual health services where minimal demographic information is available for linking to ethnicity data.
The proportion positive varied by ethnic group; 0.8% of individuals of black or black British ethnic background tested positive compared to 0.5% of individuals of mixed or other ethnic background, 0.3% of white or white British ethnic background and 0.2% of Asian or Asian British ethnic background.
Table 8. Number of tests, adults (16+ years old) tested, and adults (16+ years old) testing positive for HIV in participating centres by ethnic group (excluding antenatal testing), January to December 2021*
| Ethnic group | Number of tests | Number of individuals tested | Number HIV positive (%) |
|---|---|---|---|
| Asian or Asian British ethnic background | 25,802 | 21,572 | 48 (0.2) |
| Black or black British ethnic background | 49,930 | 38,579 | 297 (0.8) |
| Mixed or other ethnic background | 10,105 | 8,437 | 41 (0.5) |
| White or white British ethnic background | 187,773 | 155,129 | 510 (0.3) |
| Unknown ethnic background | 379,984 | 330,637 | 2,090 (0.6) |
*Excludes individuals aged under 16, antenatal screening, dried blood spot testing, oral fluid testing, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, soundex and first initial; all data is provisional. The proportion positive is calculated using number of individuals. Number of tests includes all tests until a person is diagnosed positive; no tests are counted after a positive test; a person can be counted more than once.
7. HTLV testing
In 2021, 12,296 individuals were tested at least once for HTLV-1 specific antibodies in 11 participating sentinel centres. Overall, 176 (1.4%) individuals tested positive, the region distribution can be found in Supplementary Table 17.
The age and gender of individuals tested for HTLV-1 were well reported (>96% complete) (Supplementary Table 18). Where known (11,962), 54.9% of individuals testing were male, with positivity higher in females compared to males (1.7% vs. 1.1% respectively, p= 0.008). The highest proportion of tests were among those aged 55 to 64 years old and those aged 65 years and over (both 22.2%, respectively). Positivity was highest among those aged between 35 and 44 years (1.9%), followed by those aged between 45 and 54 years (1.7%) and those aged between 1 to 14 (1.5%). The median age of individuals tested was 52 years (IQR: 36 to 63) and the median age of individuals testing positive was 49 years (IQR: 35 to 61).
Where known (13,001; 99.3%), the greatest proportion of individuals (39.3%) were tested in other ward type, with a further 18.0% in renal services and 17.7% by a hospital which referred all HTLV samples to a sentinel centre.
Of the individuals tested for HTLV, where ethnicity was known (n=8,824) (Supplementary Table 19), the majority of individuals were of white or white British ethnic background (78.0%), a further 10.7% were of black or black British ethnic background, 7.9% were of Asian or Asian British ethnic background, and 3.4% were of mixed or other ethic background. The proportion positive varied by ethnic group; 5.3% of individuals of black or black British ethnic background tested positive compared to 3.4% among individuals of mixed or other ethic background, 1.1% among individuals of Asian or Asian British ethnic background and 0.7% among individuals of white or white British ethnic background.