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Leeds is an area of high HIV prevalence of 2.3/1000 and in accordance with National UK guidelines for HIV testing we introduced routine opt out HIV testing to the acute medicine unit at St. James’s University hospital in January 2015. Opt out testing is offered to patients between 16 and 65 years of age admitted to any of the acute medical areas.Ensuring high testing rates in this busy environment with rapidly changing medical staff is challenging and we have used a number of interventions to help sustain a high testing rate. These include providing weekly feedback and training to the acute medicine doctors and nurse practitioners, an electronic prompt on the Ordercoms pathology system and for patients who have blood tests in the emergency department, the facility to have HIV testing performed on samples sent to biochemistry. We employ a 0.5 WTE nurse to support this project.Between January 2015 and February 2017 there have been 11,715 eligible patients admitted of which 7263 (61%) patients underwent HIV testing. HIV testing was highly acceptable to patients with almost no patients refusing the offer of an HIV test. 16 patients (0.22%) had a positive HIV test and 2 partners were subsequently tested positive. 10 of the 16 patients had a very late diagnosis with a CD4 count <200 cells/mm3 and we identified many missed opportunities for earlier diagnosis. 2 patients had primary HIV infection and would almost certainly not have been tested otherwise.