Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infections are important causes of morbidity and mortality among people living with HIV (PLHIV), particularly in sub-Saharan Africa. Although several studies have documented the burden of HIV–hepatitis co-infection in urban and peri-urban settings in Tanzania, data from rural western regions remain limited. This study aimed to determine the seroprevalence of HBV and HCV among HIV-positive adults receiving antiretroviral therapy (ART) in Kakonko District, western Tanzania. A facility-based cross-sectional study was conducted among HIV-positive adults aged ≥ 18 years attending three Care and Treatment Clinics in Kakonko District. Participants were selected using simple random sampling. Sociodemographic and clinical data were collected using a structured questionnaire. Finger-prick blood samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using rapid immunochromatographic assays. Data were analyzed using Stata version 16, and seroprevalence was calculated with 95% confidence intervals. A total of 283 HIV-positive adults on ART were included in the analysis. Females accounted for 66% of participants, and 63% were aged below 45 years. More than half of the participants had been on ART for over five years, and 98% were receiving a tenofovir–lamivudine–dolutegravir (TLD)-based regimen. None of the participants tested positive for HBsAg or anti-HCV antibodies. No cases of dual HBV/HCV infection were identified, yielding a seroprevalence of 0% for HBV, HCV, and HBV/HCV co-infection. No evidence of HBV or HCV co-infection was found among HIV-positive adults receiving ART in Kakonko District. Long-term ART use and effective HIV prevention and care interventions may have contributed to these findings. Continued routine hepatitis screening and integration of viral hepatitis services within HIV care programs are recommended to sustain low co-infection rates.

HIV, Hepatitis B, Hepatitis C, Co-infection, Antiretroviral therapy, Rural Tanzania