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Background and Aims Opt-out blood-borne virus (BBV) testing for Hepatitis B (HBV) infection has been carried out in selected emergency departments (ED) across England since April 2022. Here we describe patients with newly diagnosed chronic HBV from ED testing at two large NHS Trusts in Southeast London in the first 20 months of testing.Method Patients with reactive hepatitis B surface antigen (HBsAg) results from ED were contacted and their hospital and GP records analysed to establish if this was new or known diagnosis. Clinical data and details on linkage to care were collected for all new diagnoses made between November 2022 to June 2024.Results In the 20-month period, 1188 patients were reactive for HBsAg; 353 had a new HBV diagnosis. 13 presented with clinically overt cirrhosis and 3 had hepatocellular carcinoma (HCC) diagnosed during the admission. 254 new patients (71.9%) were contactable and accepted a first appointment; 202 attended this first appointment, including 169 having transient elastography (Fibroscan) assessment. Of the patients who had a Fibroscan assessment, 19 (11.2%) had liver stiffness measurements (LSM) of 7–11kPa and 9 (5.3%) had a LSM of > 11kPa. 61 patients have a calculated APRI score of 0.5–1.0 and 26 patients a score of > 1.0.44 patients have been initiated on nucleos(t)ide analogue treatment since diagnosis. However, based on the World Health Organisation (WHO) 2024 guidance (APRI > 0.5 or HBV DNA >2000 IU/mL andALT above upper limit of normal) 123 (34.8%) of the newly diagnosed patients meet criteria for initiating treatment. Furthermore 138 patients (39.1%) warrant HCC surveillance based on EASL guidelines; a significant proportion of this cohort being Black Afro-Caribbean males over the age of 40.74 patients seen in one ED with known chronic HBV but lost to specialist follow up (LTFU) were identified and analysed. 53 patients (71.6%) were re-linked to care, 26 patients (35.1%) meet theWHO 2024 treatment criteria, and 32 (43.2%) patients require HCC surveillance.Conclusion Patients with HBV identified through ED testing represent a significant burden of clinical disease. In the first 20-months of ED testing in Southeast London, 34.8% of those newly diagnosed meet treatment criteria and 39.1% require surveillance for HCC. ED testing is also an opportunity to re-engage LTFU patients, with success in one centre. Resource is now required to meet this increased demand on specialist services in a long-term sustainable manner with consideration for novel models of care.