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Patients aged 18\u201368 undergoing routine blood sampling were eligible for opt-in screening. We analyzed testing uptake, temporal trends, positivity rates, and linkage to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 23,118 cases were eligible for testing. Screening was offered to 2670 cases (11.5%). 2440 (91.4%) consented of whom 2406 were tested. Testing volumes remained below 11% of the eligible population.<\/jats:p>\n                    <jats:p>Among 2406 cases, 78 (3.2%) individuals were found to have at least one BBV infection.<\/jats:p>\n                    <jats:p>HIV infection was detected in 36 (1.5%) individuals. 12 individuals (0.5%) had previously undiagnosed HIV infection (median [range] CD4 count: 213\/\u00b5L [66\u2013794]). Linkage to care was successful in 50.0%.<\/jats:p>\n                    <jats:p>HBV was found in 16 (0.7%) individuals, with 6 (0.2%) previously undiagnosed individuals; linkage to care was achieved in 33.3%.<\/jats:p>\n                    <jats:p>HCV was confirmed in 38 (1.6%) individuals, including 13 (0.5%) previously undiagnosed individuals; linkage to care was achieved in 15.4%.<\/jats:p>\n                    <jats:p>Homelessness, substance use, and lack of health insurance coverage were key barriers to successful linkage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Universal BBV testing in an urban ED proved effective in identifying previously undiagnosed infections. However, due to its opt-in design, the program operated below its potential capacity. Linkage to care was often unsuccessful, largely due to structural barriers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02710-w","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T16:28:49Z","timestamp":1765816129000},"page":"795-805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Universal opt-in HIV, HBV and HCV testing in an emergency department: implementation and outcomes of a comprehensive screening program"],"prefix":"10.1007","volume":"54","author":[{"given":"Kira Sophia","family":"H\u00fclsd\u00fcnker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Grieser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Migaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Drauz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keikawus","family":"Arast\u00e9h","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Stocker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"2710_CR1","unstructured":"Global Burden of Disease 2021 [Internet]. 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