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While many studies have examined the role of biochar in carbon (C) accrual in short-term scale, few have explored the decadal scale influences of biochar on non-biochar C, e.g., native soil organic C (SOC) and added substrate. To address this knowledge gap, soils were collected from decade-old biochar field trials located in the United Kingdom (Cambisol) and China (Fluvisol), with each site having had three application rates (25–30, 50–60 and 75–100 Mg ha−1) of biochar plus an unamended Control, applied once in 2009. We assessed physicochemical and microbial properties associated with sucrose (representing the rhizodeposits) mineralization and the priming effect (PE) on native SOC. Here, we showed both soils amended with biochar at the middle application rate (50 Mg ha−1 biochar in Cambisol and 60 Mg ha−1 biochar in Fluvisol) resulted in greater substrate mineralization. The enhanced accessibility and availability of sucrose to microorganisms, particularly fast-growing bacterial genera like Arenimonas, Spingomonas, and Paenibacillus (r-strategists belonging to the Proteobacteria and Firmicutes phyla, respectively), can be attributed to the improved physicochemical properties of the soil, including pH, porosity, and pore connectivity, as revealed by synchrotron-based micro-CT. Random forest analysis also confirmed the contribution of the microbial diversity and physical properties such as porosity on sucrose mineralization. Biochar at the middle application rate, however, resulted in the lowest PE (0.3 and 0.4 mg of CO2-C g soil−1 in Cambisol and Fluvisol, respectively) after 53 days of incubation. This result might be associated with the fact that the biochar promoted large aggregates formation, which enclosed native SOC in soil macro-aggregates (2–0.25 mm). Our study revealed a diverging pattern between substrate mineralization and SOC priming linked to the biochar application rate. This suggests distinct mechanisms, biophysical and physicochemical, driving the mineralization of non-biochar carbon in a field where biochar was applied a decade before. Highlights: The application of biochar at a moderate rate (50–60 Mg ha−1) resulted in increased labile C mineralization and decreased priming of native SOC. Biochar amendments led to the reconfiguration of physicochemical properties, including pH, porosity, and the formation of aggregates. Modified microbial community structure towards more r-strategists caused greater sucrose mineralization. Biochar incorporation rate governed the C dynamics via (biophysical vs physicochemical mechanisms) in long-term biochar amended fields. [ABSTRACT FROM AUTHOR]

This study aimed to explore the soil metabolic response to long-term fertiliser application and the effect of this response on the microbial community by taking advantage of the Woburn Organic Manuring Experiment (UK; operational since 1964). Untargeted metabolomes detected by gas chromatography-time of flight mass spectrometer/mass spectrometry (GC-TOFMS/MS) and ultra-high-pressure liquid chromatography-quadrupole time of flight mass-spectrometer/mass spectrometry (UHPLC-QTOFMS/MS) were used to explore which method better reflected soil microbe-accessible metabolites. Microbial community abundance was detected by high-throughput sequencing. We found that long-term farmyard manure application enhanced the soil's total and dissolved C and N contents. The metabolite content detected by GC-TOFMS/MS (TOF detector with a cold injection unit) had a negative linear correlation with soil organic matter, extractable organic nitrogen (N), and microbial carbon (C). Conversely, the metabolite content detected by UHPLC-QTOFMS/MS was positively correlated with soil organic matter, indicating that metabolites detected by UHPLC-QTOFMS/MS were the main components of soluble soil organic matter. More positive than negative correlations were observed between metabolites and bacterial (69.5%) and fungal (67.9%) taxa in the co-occurrence network. Among the bacterial taxa in the network, the family Planococcaceae and genus Paenibacillus showed the most correlations with metabolites. The choice of extraction and detection method affects the identity and number of metabolites detected. Therefore, careful consideration is needed when selecting which methods to use. We demonstrated a strong correlation between soil metabolites and microbial community abundance. However, a deeper understanding of soil microbial function and metabolite formation, content, and decomposition is still needed. [ABSTRACT FROM AUTHOR]

Here we describe and evaluate the success of a multi‐institutional Centre for Doctoral Training (CDT), which was established to address a UK skills shortage in Soil Science. The government‐funded 'STARS' (Soils Training And Research Studentships) CDT was established in 2015 across a range of universities and research institutes in the UK. It recruited 41 PhD students equitably split across the institutions under four core research themes identified as being central to the national need, namely, (1) Understanding the soil–root interface, (2) Soils and the delivery of ecosystem services, (3) Resilience and response of functions in soil systems and (4) Modelling the soil ecosystem at different spatial and temporal scales. In addition, the STARS CDT provided a diverse skills programme, including: Holistic training in soils, the promotion of collegiality and joint working, strategies to promote science and generate impact, internships with end users (e.g., policymakers, industry), personal wellbeing, and ways to generate a lasting soils training legacy. Overall, both supervisors and students have reported a positive experience of the CDT in comparison to the conventional doctoral training programmes, which have less discipline focus and little chance for students to scientifically interact with their cohorts or to undertake joint training activities. The STARS CDT also allowed students to freely access research infrastructure across the partner institutions (e.g., long‐term field trials, specialised analytical facilities, high‐performance computing), breaking down traditional institutional barriers and thus maximising the students' potential to undertake high‐quality research. The success and legacy of the STARS CDT can be evidenced in many ways; however, it is exemplified by the large number and diversity of journal papers produced, the lasting collaborations, final career destinations, and creation of a web‐based legacy portal including new and reflective video material. Highlights: Soil science was identified as having a scientific skills shortage in the UK.A dedicated soil science Centre for Doctoral Training (CDT) was established to address this skills gap.The multi‐institutional, discipline‐focused CDT proved more successful than conventional generic PhD training programmes.The CDT model provides critical mass to provide more effective training of soil scientists. [ABSTRACT FROM AUTHOR]

As the UK leaves the European Union, the Common Agricultural Policy (CAP), which for decades has dictated how and when farming support is delivered, will be replaced with a new UK agricultural policy which will see UK farmers, especially upland livestock farmers, facing a more challenging economic environment and a significant change to the way in which farming support is delivered. This study used a series of interviews with UK farmers across differing locations and categories to ascertain how levels of social capital may hinder or enhance a farmer's willingness to embrace future agricultural policy. We found that more conventional farmers who have never participated in agri-environment schemes and those currently in government-run schemes display high levels of bonding capital and low levels of bridging and linking capital which may hinder their ability to adapt to change. In contrast, farmers who embrace a pubic goods approach to land management displayed high bridging and linking capital and are more likely to work with government officials to adapt to policy change. Communities are more likely to become sustainable if they have access to government support and advice, and if relationships with other community members and stakeholders with an interest in rural communities, the natural environment and land management are encouraged and maintained. • Conventional farmers access high levels of bonding social capital. • High Nature Value Farmers access high levels of bridging and linking social capital. • As farmers' community roles diminish, community co-operative action reduces. • The government must shift from controller and provider to catalyst and facilitator. [ABSTRACT FROM AUTHOR]

Extreme weather events have become a dominant feature of the narrative surrounding changes in global climate with large impacts on ecosystem stability, functioning and resilience; however, understanding of their risk of co‐occurrence at the regional scale is lacking. Based on the UK Met Office's long‐term temperature and rainfall records, we present the first evidence demonstrating significant increases in the magnitude, direction of change and spatial co‐localisation of extreme weather events since 1961. Combining this new understanding with land‐use data sets allowed us to assess the likely consequences on future agricultural production and conservation priority areas. All land‐uses are impacted by the increasing risk of at least one extreme event and conservation areas were identified as the hotspots of risk for the co‐occurrence of multiple event types. Our findings provide a basis to regionally guide land‐use optimisation, land management practices and regulatory actions preserving ecosystem services against multiple climate threats. [ABSTRACT FROM AUTHOR]

The response of nitrifier and denitrifier populations and associated N2O emissions to different carbon-to-nitrogen (C/N = 17 or 45) straw amendments was monitored under flooding-drying and non-flooding conditions. A 10-week laboratory mesocosm study was conducted in two soils, (i) a paddy soil with a long history of managed flooding-drying (CN), and (ii) a wheat cropping soil with no previous history of flooding (UK). We measured N2O fluxes and the abundances of ammonia-oxidizing archaea (AOA) and bacteria (AOB), nitrite reductase (nirK and nirS) genes, and nitrous oxide reductase (nosZI and nosZII) genes during flooding (4 weeks) and post-flooding (6 weeks). Straw addition enhanced N2O emissions, with higher fluxes apparent after incorporation of narrow C/N residues. Moreover, the impact of crop amendment on N2O emission was exacerbated when soil was under flooding-drying conditions. The abundances of nirS and nosZI genes in CN soil and AOA gene in UK soil were increased by straw amendment, with highest in narrow C/N straw amendments. Structural equation modeling showed that the impact of denitrifier gene abundance on the N2O flux was stronger than that of nitrifier gene abundance in the two soils, and significant correlations were observed between N2O fluxes and the consumption of DOC and NO3−, indicating that denitrification was the dominant N2O production pathway during the drying phase. The ratio of (nirS + nirK)/(nosZI + nosZII) in the narrow C/N amendment was greater than in the wide C/N treatment after flooding, suggesting that the straw C/N ratio had an effect on the capacity for N2O production via denitrification. We conclude that crop amendments with an appropriate C/N ratio could minimize N2O fluxes through regulating the denitrification process when soils are subjected to regular flooding and drying and also experiencing greater frequencies of flooding. [ABSTRACT FROM AUTHOR]

• Extreme winter flooding negatively altered soil physical, chemical and biological indicators. • Soil available P was reduced by 42% in the flooded areas after the flood event. • Plant biomass in arable fields was reduced by 19–34% in flooded areas. • Total soil microbial biomass increased by 60% after flooding. • Grassland soils were more resilient than other crops. Evidence suggests that climate change is increasing the frequency of extreme weather events (e.g. excessive rainfall, heat, wind). The winter of 2013-14 saw exceptional levels of rainfall across the UK leading to extreme and prolonged flooding (up to 3 months with floodwater depths up to 3 m) in several low-lying agricultural areas (e.g. Somerset Levels, Thames Valley). The impact of extreme flooding and the speed of ecosystem recovery at the field-scale, however, remain poorly understood. The main objectives of this study were therefore to: (1) assess the effect of this extreme winter flooding event on a range of soil physical, chemical and biological quality indicators at 15 flood-affected sites (arable and grassland), (2) determine if these changes in soil health were reversible in the short term (< 1 year), and (3) to evaluate the effectiveness of different mechanical interventions (sward-lifting, subsoiling, slot-seeding and aerating) to accelerate the amelioration of the damage caused by winter flooding at 2 of the 15 sites. Once the floodwater had receded (April 2014), we found that several of the measured soil quality indicators were negatively affected in the flooded areas in comparison with non-flooded areas. This included a decrease in soil bulk density (by 19%), soil pH (by 0.4 units), and available P (by up to 42%). Flooding increased soil microbial biomass (60%), induced a shift in soil microbial community structure and reduced earthworm numbers. After 8 months of recovery, only soil pH remained significantly reduced (by 0.3 units) in the flooded areas in comparison to the unflooded areas. Flooding had a negative impact on the overlying vegetation at the arable sites (biomass production was reduced by between 19 and 34%) but had no major impact at the grassland sites in the long-term. In the flood amelioration experiment, the subsoiled plots produced grass with a higher nutrient content (e.g. N - up to 35%, Ca - up to 19% and Mg - up to 58%). However, the four different interventions appeared to have little positive impact on most of the soil quality indicators measured. In conclusion, extreme winter flooding was found to induce short-term alterations in key soil quality indicators and to destroy winter crops, although these effects did not persist in the longer term. Our results therefore indicate that the temperate agroecosystems evaluated here were highly resilient to winter flood stress and that recovery to a pre-flood state could be achieved within 1 year. Improved management strategies are still needed to speed up the rate of recovery after flood events to facilitate a faster return to agricultural production. [ABSTRACT FROM AUTHOR]

• Evaluating the extent of reliance upon Pillar 1 payments in UK/Welsh farms. • Approximately 34% of Welsh farm holdings face serious financial difficulties. • 44% of agricultural land in Wales is vulnerable to land use change or abandonment. • There are social and ecological risks associated with land use change. • A balanced approach keeps farmers on the land and delivers quality 'Public Goods'. On the 23rd June 2016, the UK referendum on European Union (EU) membership resulted in a vote to leave the EU. This departure, should it occur, would see the implementation of a new agricultural policy within the UK which will most likely see the removal of direct financial support to farmers. In this study, we use combined agricultural survey and rural payments data to evaluate the extent of reliance upon Pillar 1 payments, based on a sample of 24,492 (i.e. 70%) of farm holdings in Wales. This approach eliminates some of the variation found in the Farm Business Survey through the delivery of a more comprehensive picture on the numbers and types of farm holding potentially facing economic hardship and the quantities of land and livestock associated with those holdings. We estimate ˜34% of our sampled Welsh farm holdings face serious financial difficulties and show ˜44% of agricultural land on sampled farm holdings in Wales being vulnerable to land use change or abandonment. Based on our results, we consider the potential social and ecological impacts that the removal of direct payments may have on land use in Wales. We also discuss the use of a more balanced approach to land management that could support governmental visions to keep farmers on the land, improve productivity and deliver high quality 'Public Goods'. [ABSTRACT FROM AUTHOR]

Argues that HIV specialists must give asylum seekers the care that they need. The extra burden on the NHS is one of the issues cited in the controversy over the number of asylum seekers entering the United Kingdom. The second view is that most of the HIV positive asylum seekers are either "health tourists" (coming here for treatment they couldn't afford at home) or economic migrants abusing our system, and we shouldn't be using scarce resources on them. I suspect that although most healthcare professionals who come into contact with this group of patients would admit that both sides of the argument have some truth they largely sympathise with the first point of view. Until such universal care is available, HIV specialists have no realistic option, practically or ethically, but to give HIV positive asylum seekers the care they need and to support their applications to remain in Britain.

Herbal leys (multispecies swards) can potentially deliver greater agronomic and environmental benefits than conventional grass-clover swards in grazed agroecosystems. However, despite their popularity in agri-environment schemes, little is known about the effect of herbal leys on soil physical (e.g., porosity), chemical (e.g., carbon), and biological (e.g., soil fauna) characteristics. In the UK, a 2-ha replicated-field experiment utilising a herbal or grass-clover ley (n = 3 per sward) aimed to investigate the effect of sward type on soil quality. Each sward was rotationally grazed by weaned lambs (3.2 LU ha−1) over two grazing seasons, with soil physiochemical and biological characteristics assessed after 2-years using techniques such as X-ray micro-Computed Tomography (µCT) and microbial shallow shotgun sequencing. Soil chemical characteristics (e.g., pH) were unaffected by sward type. Similarly, topsoil (0–10 cm) organic carbon stocks measured after 2-years did not differ between the herbal (26.1 ± 1.1 t C ha−1) and grass-clover ley (25.7 ± 1.1 t C ha−1). X-ray µCT analysis revealed greater pore connectivity (Euler number) in grass-clover ley intact soil cores (0–10 cm depth, 7.5 cm width) than herbal ley cores dominated by Plantago lanceolata (p = 0.008). However, there was no sward-type difference in aggregate stability or general pore characteristics, determined using X-ray µCT, in air-dried 4 mm aggregates obtained from 0–5 or 5–10 cm depth, nor did sward type affect earthworm abundance, microbial community composition or the functional gene profile. This study is the first to explore the effects of a commercial herbal ley on physical, chemical, and biological soil quality indicators in a rotationally grazed sheep pasture. While no improvements in soil quality indicators were observed after 2-years, these findings have significant implications for agri-environment schemes promoting herbal leys to achieve soil quality and sustainability, with further research needed to optimise the seed mixture and management regime to deliver greater long-term below-ground ecosystem service benefits. [Display omitted] • Increasing grassland species richness can improve soil quality. • X-ray µCT showed greatest pore connectivity in intact grass-clover ley cores. • Sward type did not affect soil physical or chemical characteristics. • Sward diversity did not affect earthworm abundance or microbial community composition. [ABSTRACT FROM AUTHOR]

The BNT162b2/Pfizer SARS-CoV-2 vaccine has been widely used in the UK, particularly amongst healthcare workers (HCWs). To establish whether previous COVID-19 influenced vaccine-associated Adverse Events (AEs), we conducted a survey-based study of HCWs in Northeast England. Out of 1238 HCWs, 32% self-reported prior positive PCR and/or antibody test for SARS-CoV-2. Post-dose AEs were worse in those with prior COVID-19 after the first, but not the second dose of vaccine. Second dose AEs were greater in frequency/severity, regardless of COVID-19 history, and they were more systemic in nature. Women and younger HCW were more likely to report AEs after both doses, while dosing interval had no effect on AEs. Ongoing Symptomatic COVID-19 was associated with greater frequency/severity of AEs after dose 2, but not dose one. Overall, AEs were self-limiting and short-lived (i.e.,<48 h) in nature. These findings have implications for vaccine hesitancy and informing guidelines for recommended dosing protocols. [ABSTRACT FROM AUTHOR]

Abstract: Current research on macronutrient cycling in UK agricultural systems aims to optimise soil and nutrient management for improved agricultural production and minimise effects on the environment and provision of ecosystem services. Nutrient use inefficiencies can cause environmental pollution through the release of greenhouse gases into the atmosphere and of soluble and particulate forms of N, P and carbon (C) in leachate and run-off into watercourses. Improving nutrient use efficiencies in agriculture calls for the development of sustainable nutrient management strategies: more efficient use of mineral fertilisers, increased recovery and recycling of waste nutrients, and, better exploitation of the substantial inorganic and organic reserves of nutrients in the soil. Long-term field experimentation in the UK has provided key knowledge of the main nutrient transformations in agricultural soils. Emerging analytical technologies, especially stable isotope labelling, that better characterise macronutrient forms and bioavailability and improve the quantification of the complex relationships between the macronutrients in soils at the molecular scale, are augmenting this knowledge by revealing the underlying processes. The challenge for the future is to determine the relationships between the dynamics of N, P and C across scales, which will require both new modelling approaches and integrated approaches to macronutrient cycling. [Copyright &y& Elsevier]

• Fewer UK beef & sheep farmers adopt soil index tests than farmers from other sectors. • We explored factors influencing soil testing adoption in the beef & sheep sector. • Differences in pressures and practice explain sectoral differences in soil testing. • Beef & sheep farmer engagement with advisors results in higher use of soil test data. • Linking soil condition to farm outputs is more likely to prompt greater engagement. Soil testing in agriculture is associated with many economic and environmental benefits. However, previous studies have shown that a significant proportion of beef and sheep farmers in the UK do not carry out standard soil index testing (pH, available Mg, P and K); with much fewer again carrying out more extensive soil tests (e.g., organic matter, micronutrients). This study identifies barriers and motivations to soil testing amongst the beef and sheep sector, using a combination of farmer surveys, expert interviews, and a 5-year soil testing dataset from the largest commercial UK soil testing laboratory. Evidence for differences in the adoption of soil tests by beef and sheep farmers compared to the arable and dairy sectors is explained in relation to: (1) the extent of soil pH and nutrient imbalances, linking to the intensity of management in the different sectors; and (2) the extent to which farmers perceive links between their soils and their outputs (profits, yield, livestock health). We show a greater likelihood for farmers to engage with soil testing when the links to declining outputs are clearer. Our results showed that beef and sheep farmers who did engage with soil testing showed greater levels of innovation and were more likely to seek advisory support, most often associated with larger farm sizes. Our data also highlights the importance of an output-driven approach to initiate an interest in soil analyses amongst less engaged farmers. We argue that this avenue offers greater potential for enhancement of farmers' knowledge of the soil system than a primarily regulatory-driven approach, where soil testing becomes a compulsory action but does not lead to subsequent improvements in farm management. [ABSTRACT FROM AUTHOR]

Objective: The worldwide spread of SARS-CoV-2 and the resulting COVID-19 pandemic has been driven by international travel. This has led to the desire to develop surveillance approaches which can estimate the rate of import of pathogenic organisms across international borders. The aim of this study was to investigate the use of wastewater-based approaches for the surveillance of viral pathogens on commercial short-haul (3.5 h transit time) roll-on/roll-off passenger/freight ferries operating between the UK and the Republic of Ireland., Methods: Samples of toilet-derived wastewater (blackwater) were collected from two commercial ships over a 4-week period and analysed for SARS-CoV-2, influenza, enterovirus, norovirus, the faecal-marker virus crAssphage and a range of physical and chemical indicators of wastewater quality., Results: A small proportion of the wastewater samples were positive for SARS-CoV-2 (8% of the total), consistent with theoretical predictions of detection frequency (4%-15% of the total) based on the national COVID-19 Infection Survey and defecation behaviour. In addition, norovirus was detected in wastewater at low frequency. No influenza A/B viruses, enterovirus or enterovirus D68 were detected throughout the study period., Conclusion: We conclude that testing of wastewater from ships that cross international maritime boundaries may provide a cost-effective and relatively unbiased method to estimate the flow of infected individuals between countries. The approach is also readily applicable for the surveillance of other disease-causing agents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Jones, Bridgman, Pellett, Weightman, Kille, García Delgado, Cross, Cobley, Howard-Jones, Chadwick and Farkas.)

Introduction: Late diagnosis of HIV is associated with increased morbidity and mortality, and an increased risk of non-infectious comorbidities. On a societal level, late diagnosis leads to higher treatment and healthcare costs and is a major driver of HIV transmission. Despite improvements in other areas of the HIV care pathway, late diagnosis remains an individual and public health concern globally., Objective: To examine the barriers to HIV testing and highlight successful strategies to improve prompt diagnosis. This review describes the prevalence of late diagnosis in the UK and discusses key factors that contribute to late diagnosis, including the effect of the COVID-19 pandemic. Late HIV diagnosis is lower in the UK than in most other European countries. In this review, pilot projects and ongoing initiatives that have reduced late diagnosis in the UK are highlighted; moreover, further strategies for improving prompt diagnosis are suggested., Conclusions: Insufficient testing is the fundamental reason for late HIV diagnosis, with societal, systemic, and individual factors all contributing to inadequate testing. Improving access to testing, removing barriers to health-seeking behaviour, and ensuring all people with HIV indicator conditions are promptly tested are key to reducing the rates of late diagnosis globally., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Marta Boffito received travel grants, speaker and advisor fees, and research grants to the organisation from Janssen, Roche, ViiV, Bristol Myers Squibb, Merck Sharp & Dohme, Gilead Sciences, Mylan, Cipla, Novavax, Valneva, GSK, Atea, Moderna, Teva, AZ and Pfizer. David R Chadwick is a trustee/executive member of the British HIV Association and has recently chaired a sub-group on guidelines for Emergency Department opt-out testing using implied consent. He has also received research grants from Gilead Sciences. Samuel Kabagambe is an employee of Gilead Sciences and may own stock options in Gilead Sciences. Bakita Kasadha has previously received speaker honoraria and consultancy fees from Gilead Sciences. Cindy Elliott is an employee of Gilead Sciences and may own stock options in Gilead Sciences. Emily Boardman, and Emily Cheserem declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: HIV-2 is rare in the UK. Many UK centres therefore only treat small numbers of people and there are few clinical trials to guide treatment. The British HIV Association (BHIVA) 2010 guidelines for management of HIV-2 formed the basis for this national audit, which aims to describe current practice and adherence to guidelines., Methods: All UK centres providing HIV care were contacted via the BHIVA "Members Matters" newsletter, and asked to submit anonymised, retrospective data for individuals living with HIV-2 accessing care at their service., Results: Thirty-five sites responded and data were analysed for 167 individuals. Nearly half of individuals accessed care at one of four large London centres (77/167, 46%).Most people living with HIV-2 have taken antiretroviral therapy (ART) (132/167, 79%). The most common reasons for initiating treatment were clinical disease (34/89, 38%) and pregnancy (11/89, 12%). Most treatment-naïve individuals were initiated on a protease inhibitor based regimen (70/89, 79%). The use of integrase strand transfer inhibitor based regimens has increased over time.A significant minority of patients did not have baseline drug resistance testing performed, despite having a detectable viral load (15/52, 29%). Virological failure occurred in a minority of individuals (21/132, 16%); the most common drug regimen change in this context was the addition of an integrase strand transfer inhibitor (12/26 regimen changes, 46%)., Conclusions: Most individuals living with HIV-2 were managed according to national guidance, with key areas for improvement including the choice of ART, drug resistance testing and the management of virological failure. It is hoped that this national audit, performed in conjunction with the updated 2021 BHIVA guidelines will improve the care of individuals living with HIV-2 in the UK.

Despite HIV infection being a treatable chronic illness and the many advances in testing for HIV, late diagnosis is still common, with associated avoidable morbidity and mortality. Requirements for explicit consent for HIV testing in the UK differ from those for other blood tests and are major barriers to testing. We argue that the disparity is illogical and outdated. We propose a model for normalising HIV testing that allows for routine testing in various health-care settings via implied consent, where other blood tests are performed. Inclusion of testing for hepatitis B and hepatitis C might also be incorporated into this model. The ethical argument for this approach is principally beneficence towards people with undiagnosed infection and the people they might infect. Patient autonomy would be maintained using systems allowing for individuals to opt out of implied consent., Competing Interests: Declaration of interests DRC is currently an executive trustee of the British HIV Association (BHIVA), and Chair of the BHIVA Audit and Standards Subcommittee. He reports research grants from Innovate UK and Gilead Sciences, and lecture fees from Gilead Sciences. He is also a member of the Independent Data Monitoring Committee for the Flare trial (funded by LifeArc). EP reports a research grant from Gilead Sciences. For JS, this work was funded in part by the Wellcome Trust (grant number WT203132/Z/16/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. JS, through his involvement with the Murdoch Children's Research Institute, received funding from the Victorian State Government through the Operational Infrastructure Support Program. DW reports no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)