Seroprevalence and Patterns of HIV, Hepatitis B, and Hepatitis C Co-infection among Married Couples in Rural Western Tanzania: A Community-based Cross-sectional Study

Getera Isack Nyangi^1, , Godfrey Nyandidi² and Victoria Avelin Marunda³

¹District Medical Officer and Public Health Researcher, Kakonko District Council, Tanzania

²Economist, Kakonko District Council, Tanzania

³Medical Officer and District Research Coordinator, Kakonko District Council, Tanzania

Cite this paper:
Getera Isack Nyangi, Godfrey Nyandidi and Victoria Avelin Marunda. Seroprevalence and Patterns of HIV, Hepatitis B, and Hepatitis C Co-infection among Married Couples in Rural Western Tanzania: A Community-based Cross-sectional Study. American Journal of Infectious Diseases and Microbiology. 2026; 14(1):11-17. doi: 10.12691/ajidm-14-1-3

Abstract

Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) remain major global public health challenges, contributing substantially to chronic liver disease and premature mortality. Married couples represent an important population for understanding long-term exposure and potential intra-household transmission; however, data on viral infections and co-infections among couples in rural Tanzania are limited. This study aimed to determine the seroprevalence and patterns of HIV, HBV, and HCV mono-infections and co-infections among married couples in Kakonko District, Kigoma Region, western Tanzania. A community-based cross-sectional study was conducted between August and October 2025 among 263 married couples (526 individuals). Finger-prick blood samples were tested for HIV using the national rapid diagnostic testing algorithm, HBV using hepatitis B surface antigen (HBsAg) rapid tests, and HCV using anti-HCV antibody rapid assays. Socio-demographic data were collected using structured questionnaires, and data were analyzed using Stata version 16. Among 526 participants, HIV prevalence was 0.4%, HBV prevalence was 4.5%, and HCV prevalence was 0.4%. HIV–HBV co-infection was identified in one participant (0.19%), while no HIV–HCV, HBV–HCV, or triple infections were detected. Serodiscordant infection was observed in two couples for HIV, eighteen couples for HBV, and two couples for HCV, while HBV seroconcordance was identified in two couples. In conclusion, HBV infection remains moderately prevalent among married couples in Kakonko District, whereas HIV and HCV prevalence are low and viral co-infections are rare. Strengthening HBV screening, adult vaccination, and couple-based education programs is recommended.

Keywords:
HIV Hepatitis B Hepatitis C Co-infection Married couples Tanzania

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Chandra N, Joshi N, Raju YSN, Kumar A, Teja VD. Hepatitis B and/or C co-infection in HIV-infected patients: a study in a tertiary care centre from South India. Available from: www.openEpi.com
[2]	Mårdh O, Quinten C, Amato-Gauci AJ, Duffell E. Mortality from liver diseases attributable to hepatitis B and C in the EU/EEA: descriptive analysis and estimation of 2015 baseline. Infect Dis (Lond). 2020; 52(9): 625–37.
[3]	UNAIDS. Global AIDS Update 2025—AIDS, crisis and the power to transform. Geneva: Joint United Nations Programme on HIV/AIDS; 2025. Available from: https:// www.unaids.org/ en/UNAIDS-global-AIDS-update-2025.
[4]	World Health Organization. Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: WHO; 2024. Available from: https://iris.who.int/handle/10665/376461。
[5]	Operskalski EA, Kovacs A. HIV/HCV co-infection: pathogenesis, clinical complications, treatment, and new therapeutic technologies. Curr HIV/AIDS Rep. 2011; 8(1): 12–22.
[6]	Weldemhret L. Epidemiology and challenges of HBV/HIV co-infection amongst HIV-infected patients in endemic areas: a review. HIV AIDS (Auckl). 2021; 13: 485–90.
[7]	Maina DN, Nyerere AK, Gicho RW, Mwangi JM, Lihana RW. Prevalence and factors associated with hepatitis B and C co-infection among HIV-1-infected patients in Kenya. Available from: www.eahealth.org.
[8]	Seyoum E, Demissie M, Worku A, Mulu A, Abdissa A, Berhane Y. HIV, hepatitis B virus, and hepatitis C virus co-infection among HIV-positive patients in antiretroviral treatment programs in selected hospitals in Addis Ababa: a retrospective cross-sectional study. PLoS One. 2022; 17: e0267230.
[9]	Hawkins C, Christian B, Ye J, Nagu T, Aris E, Chalamilla G, et al. Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania. AIDS. 2013; 27(6): 919–27.
[10]	Mirambo MM, Kidenya BR, Silago V, Mkumbo E, Mujuni A, Mmanga KJ, et al. Hepatitis B and hepatitis C among human immunodeficiency virus-infected patients at a district hospital in Mwanza, Tanzania. World J AIDS. 2019; 9(1): 1–10.
[11]	Nagu TJ, Bakari M, Matee M. Hepatitis A, B, and C viral co-infections among HIV-infected adults presenting for care and treatment at Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health. 2008; 8: 416.
[12]	Njau AF, Robert M, Rwebembera A, Kisendi R, Maro C, Dennis G, et al. Prevalence and associated factors for HIV, HBV, and syphilis co-infections among pregnant women attending antenatal care in Tanzania. PLoS One. 2025; 20: e0329068.
[13]	Tanzania HIV Impact Survey. Tanzania HIV Impact Survey (THIS 2022–2023): Final report. Dar es Salaam: Ministry of Health, Tanzania Commission for AIDS, National Bureau of Statistics; 2023. Available from: https:// ocgs.go.tz/ ReportOCGS/ THIS20222023%20Final%20Report.pdf.
[14]	Kingwara L, Bowen N, Panpradist N, Lokamar P, Morangi V, Madada RS, et al. Evaluation of operational characteristics and performance of HIV rapid diagnostic tests: a systematic review and meta-analysis, 2012–2020. medRxiv. 2022.
[15]	Soomro RS, Shah IA, Saboor A, Bhutto AUB, Memon S. Sensitivity and specificity of hepatitis B virus screening via rapid immunoassay chromatographic test. Cureus. 2021; 13: e12909.
[16]	Tang W, Chen W, Amini A, Boeras D, Falconer J, Kelly H, et al. Diagnostic accuracy of tests to detect hepatitis C antibody: a meta-analysis and review of the literature. BMC Infect Dis. 2017; 17: 1.
[17]	Mwanza L. National guideline for mainstreaming HIV, AIDS, and non-communicable diseases interventions in the construction sector. Dodoma: Prime Minister’s Office–TACAIDS; 2023. Available from: https://www.tacaids.go.tz/uploads/documents/en-1714640625-Finalized%20Guide%20Construction%202023.
[18]	Gedefie A, Muche A, Mohammed A, Ayres A, Melak D, Abeje ET, et al. Prevalence and determinants of HIV among reproductive-age women (15–49 years) in Africa from 2010 to 2019: a multilevel analysis of demographic and health survey data. Front Public Health. 2025; 12: 1376235.
[19]	Joshi K, Lessler J, Olawore O, Loevinsohn G, Bushey S, Tobian AAR, Grabowski MK. Declining HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis of empiric data. J Int AIDS Soc. 2021; 24(10): e25818.
[20]	Msemwa B, James M, Kavishe S, Mzee H, Onesmo S, Marwa M, et al. Hepatitis B and C virus: current status among health professional students in Mwanza, Tanzania—a cross-sectional study. Afr J Health Sci. 2023; 37(3): 267–74.
[21]	Tess BH, Levin A, Brubaker G, Shao J, Drummond JE, Alter HJ, et al. Seroprevalence of hepatitis C virus in the general population of northwest Tanzania. Am J Trop Med Hyg. 2000; 62(1): 1–5.
[22]	Kanokudom S, Nilyanimit P, Puenpa J, Suntronwong N, Le DHH, Wongsrisang L, et al. A comparative national survey on the gradual decline of hepatitis C virus prevalence in Thailand, 2004, 2014, and 2024. Sci Rep. 2025; 15: 19794.
[23]	Aydin OA, Yemisen M, Karaosmanoglu HK, Sargin F, Gunduz A, Ceylan B, et al. Low prevalence of hepatitis C virus infection among HIV-positive patients: data from a large-scale cohort study in Istanbul, Turkey. Hepat Mon. 2014; 14(8): e18128.
[24]	Loarec A, Molfino L, Walter K, Muyindike W, Carnimeo V, Andrieux-Meyer I, et al. Low HCV prevalence among HIV-positive individuals in sub-Saharan Africa. Poster presented at: International Conference, 2016; Paris, France. Épicentre, Médecins Sans Frontières.
[25]	[Kassa GM, Gebreegziabxier AW, Abrahim SA, French CE, Wolday D, Dagne E, et al. Seroprevalence of hepatitis C in Ethiopia: first national study based on the 2016 Ethiopian Demographic and Health Survey. J Viral Hepat. 2024; 32(4): e14037.
[26]	Kilonzo SB, Nkandala I, Rudovick L, Jaka HM, Mirambo MM, Mshana SE, et al. Prevalence of hepatitis B virus infection in Tanzania: a systematic review and meta-analysis. J Trop Med. 2024; 2024: 4178240.
[27]	Downs LO, Campbell C, Yonga P, Githinji G, Ansari MA, Matthews PC, et al. A systematic review of hepatitis B virus prevalence and genotypes in Kenya. PLoS Glob Public Health. 2023; 3(1): e0001165.
[28]	Kafeero HM, Sendagire H, Ndagire D, Walusansa A, Kudamba A, Muwanda F, et al. Epidemiology of hepatitis B virus infection in Uganda after two decades of vaccination: a meta-analysis and meta-regression. BMC Infect Dis. 2025; 25(1).
[29]	Platt L, French CE, McGowan CR, Sabin K, Gower E, Trickey A, et al. Prevalence and burden of HBV co-infection among people living with HIV: a global systematic review and meta-analysis. J Viral Hepat. 2020; 27(3): 294–315.
[30]	Almasi-Hashiani A, Sadeghi F, Ayubi E, Rezaeian S, Moradi Y, Mansori K, et al. Prevalence of HIV, hepatitis B and C virus co-infections among Iranian high-risk groups: a systematic review and meta-analysis. Malays J Med Sci. 2019; 26(3): 37–48.
[31]	Muriuki BM, Gicheru MM, Wachira D, Nyamache AK, Khamadi SA. Prevalence of hepatitis B and C viral co-infections among HIV-1-infected individuals in Nairobi, Kenya. BMC Res Notes. 2013; 6: 363.
[32]	Opayele AV, Arege OT, Faneye AO, Olaleye DO, Odaibo GN. Prevalence of HIV, HBV and HCV among livestock merchants and slaughterhouse workers in Ibadan, Nigeria. Afr Health Sci. 2024; 24(1): 16–24.
[33]	Remera E, Tuyishime E, Kayitesi C, Malamba SS, Sangwayire B, Umutesi J, et al. HIV and hepatitis B and C co-infection among men who have sex with men in Rwanda: a respondent-driven sampling study. BMC Infect Dis. 2024; 24: 1.
[34]	Colombe S, Beard J, Mtenga B, Lutonja P, Mngara J, De Dood CJ, et al. HIV seroconversion among HIV-1 serodiscordant married couples in Tanzania: a cohort study. BMC Infect Dis. 2019; 19: 1.
[35]	Zhang L, Wang YY, Huang YJ, Wang QM, Nelson KE, Wang AQ, et al. Status of HBsAg seroprevalence among 15 million rural couples in China: a cross-sectional study. Sci Rep. 2017; 7: 42822.
[36]	Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S, et al. Prevalence of sexually transmitted viral and bacterial infections among HIV-positive and HIV-negative men who have sex with men in Toronto. PLoS One. 2016; 11(7): e0158090.