Prevalence of HBV and HCV Co-Infection with HIV Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia

Prevalence of HBV and HCV Co-Infection with HIV Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of HBV and HCV Co-Infection with HIV Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia Ismail Ebrie Ali, Lubaba Seid Awol This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8586632/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) are major causes of chronic infections and significant public health challenges, particularly in sub-Saharan Africa. Co-infection of HIV with HBV or HCV leads to accelerated disease progression and increased morbidity. Women seeking abortion care represent a population at higher risk of exposure to these infections due to unsafe procedures and multiple sexual exposures. Aims to determine the prevalence and associated factors of HBV and HCV co-infection with HIV among women seeking abortion care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. A cross-sectional study was conducted from August to November 2025 among 146 women seeking abortion care. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire. Blood samples were tested for HBsAg, anti-HCV, and HIV antibodies using rapid tests confirmed by ELISA. Data were analyzed using SPSS version 25. Logistic regression was applied to identify risk factors, with a significance level of p < 0.05. Results: The overall prevalence of HBV, HCV, and HIV infections were 6.2% , 2.1% , and 3.4% , respectively. Co-infections were observed in 1.4% (HBV/HIV) and 0.7% (HCV/HIV) of participants. Multiple sexual partners (AOR = 4.5; 95% CI: 1.5–13.7), unsafe abortion history (AOR = 3.21; 95% CI: 1.12–9.17), and needle injury (AOR = 3.8; 95% CI: 1.08–10.21) were significantly associated with infection. Conclusion: HBV, HCV, and HIV infections remain prevalent among women seeking abortion care in Dessie. Strengthening routine screening, vaccination, and health education is recommended to prevent co-infection and improve maternal health. HBV HCV HIV Co-infection Abortion Care Dessie Ethiopia Figures Figure 1 1. Introduction 1.1. Background Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) represent a syndetic trio of blood-borne pathogens. These viruses share critical transmission routes, predominantly sexual contact, parenteral exposure through contaminated needles or instruments, and vertical transmission from mother to child. Establishing chronic infection, these viruses collectively impose an overwhelming public health and clinical burden worldwide. The global crisis is staggering: approximately 296 million individuals live with chronic HBV and 58 million with chronic HCV infection, while an estimated 38 million people are affected by HIV [1–3]. The clinical consequence of HIV co-infection with either HBV or HCV is severe. Immunodeficiency induced by HIV accelerates the natural history of the hepatitis infections, leading to significantly higher rates of HBV and HCV viral replication and increased liver inflammation. This expedited process drastically raises the risk of end-stage liver disease, including cirrhosis, liver failure, and hepatocellular carcinoma (HCC), substantially increasing all-cause mortality among co-infected individuals [4]. In the context of Ethiopia, the burden remains substantial, characterized by an intermediate endemicity for HBV (prevalence estimated between 4–7%), HCV prevalence typically between 1–3%, and general population HIV prevalence around 2% [5]. Women seeking abortion care are an epidemiologically and socially vulnerable population. Their heightened risk for HBV, HCV, and HIV exposure is multi-factorial, stemming from a confluence of high-risk sexual behavior, potential exposure to multiple partners, and, critically, historical or current reliance on unsafe medical or traditional practices where non-sterile instruments are used [6]. Given that these women are actively engaged in the reproductive health system, identifying and intervening in this specific high-risk cohort is a vital step toward a comprehensive strategy for reproductive and maternal health. 1.2. Statement of the Problem Despite remarkable global progress in expanding access to prophylactic measures, such as the HBV vaccine, and effective treatment options for HIV (Antiretroviral Therapy) and HCV (Direct-Acting Antivirals), co-infections persist as a profound threat to women’s reproductive health and survival, particularly in resource-limited settings. The deadly synergy created by these viruses’ means that a lack of screening for one can undermine successful treatment for another. Current public health efforts often focus on routine antenatal care (ANC) screening, which may exclude women utilizing other sensitive reproductive health services, such as abortion care. Dessie Comprehensive Specialized Hospital is a critical referral center for the South Wollo Zone, handling a significant volume of abortion and post-abortion care clients. Due to the inherent risk factors associated with this population, there is an urgent necessity to quantify the precise burden of these co-infections within this facility's catchment area. Currently, there is a distinct void of local epidemiological data detailing the prevalence, incidence, and specific behavioral or clinical determinants of HBV/HIV and HCV/HIV co-infection among women utilizing abortion services in Dessie. This data deficit severely hinders the ability of local health administrators and clinicians to formulate evidence-based, cost-effective screening policies allocate resources appropriately, and design targeted intervention strategies to interrupt the transmission cycle. 1.3. Significance of the Study The findings derived from this research are expected to have multi-level practical and public health significance: Policy and Planning: The study will provide local health authorities, including the Amhara Regional Health Bureau and Dessie Comprehensive Specialized Hospital, with crucial baseline data to justify the integration of mandatory HBV and HCV screening into routine abortion care services. Clinical Management: By identifying the specific co-infection rates, the study will help clinicians optimize treatment protocols for HIV-positive patients, ensuring that appropriate antiviral regimens are selected that address both the retrovirus and the hepatitis virus simultaneously, thereby preventing treatment failure and severe liver outcomes. Targeted Intervention: The identification of specific, high-prevalence risk factors (e.g., multiple sexual partners, unsafe abortion history) will allow for the development of focused, culturally sensitive health education and counseling messages tailored specifically for women utilizing reproductive health services. Future Research: The results will serve as critical foundational data for future, larger-scale cohort studies, helping researchers track trends, evaluate the impact of intervention programs, and guide resource allocation throughout the region. 1.4. Objectives General Objective To assess the prevalence and associated factors of HBV and HCV co-infection with HIV among women seeking abortion care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. Specific Objectives: To determine the prevalence of HBV, HCV, and HIV infections among women seeking abortion care. To identify factors associated with HBV, HCV, and HIV infections among the study population. 2. Literature Review 2.1. Global Overview The global co-infection landscape underscores the challenge. It is estimated that 2.7 million people are co-infected with HBV/HIV, and 2.3 million are co-infected with HCV/HIV worldwide [7]. In regions characterized by high rates of parenteral transmission, such as certain parts of Asia and Sub-Saharan Africa, co-infection prevalence is particularly high due to the viruses exploiting the same routes of entry. The presence of HIV infection leads to blunted immune responses to the hepatitis viruses, resulting in higher viral loads and significantly increased progression to severe liver disease compared to mono-infection [4]. 2.2. Sub-Saharan Africa Sub-Saharan Africa bears the highest burden of HIV globally, alongside a high prevalence of chronic HBV, classifying most regions as hyper-endemic or intermediate-endemic. HBV prevalence across the region ranges typically from 6% to 10%, HCV from 1–5%, and HIV from 3–12%, depending on the specific demographic and geographic area studied [8, 9]. This concentration of viruses leads to clinically relevant co-infection rates. For instance, studies conducted among reproductive-age women in countries like Nigeria and Kenya have reported co-infection rates in the range of 3–6% [8, 10]. These findings highlight the need to move beyond standard antenatal screening to include vulnerable, high-risk groups to capture the full scope of viral transmission. 2.3. Ethiopia In Ethiopia, national and regional studies consistently place HBV prevalence among various cohorts (including blood donors, antenatal, and abortion care clients) within the range of 4%–7%, firmly establishing the country in the intermediate endemicity category. HCV prevalence is typically lower, fluctuating around 1%–3% [11–13]. The co-infection rates with HIV nationally are generally reported to vary between 1% and 2%. Literature from different regions points to common risk factors such as history of unsafe procedures (including traditional practices and unsterile medical/dental interventions), multiple sexual partners, and history of blood transfusions as being critical drivers [14]. For example, a study in Bahir Dar highlighted specific vulnerabilities among women seeking reproductive health services, further validating the necessity of focusing on this cohort [15]. According to the Ethiopia Ministry of Health (Reference 2020), the national HIV prevalence is 2%; however, the prevalence in this specific cohort is notably higher at 3.4% [16, 17]. 3. Materials and Methods 3.1. Study Area and Design A hospital-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital (DCSH), located in Dessie town, South Wollo Zone, Amhara Region. DCSH is a major referral hospital, attracting patients from a broad catchment area. The study was executed over a four-month period, from August to November 2025. 3.2. Study Population The study population consisted of women aged 18 years and above who were seeking medical care for induced or spontaneous abortion services at Dessie Comprehensive Specialized Hospital during the designated study period. 3.3. Sample Size and Sampling Technique The final sample size (n = 146) was calculated using the single population proportion formula. The calculation assumed an estimated prevalence (P) of 4.4% (based on previous studies of similar populations), a 95% confidence level, a5% margin of error, and an allowance for a 10% non-response rate. Participants were systematically selected from the target population arriving at the abortion care unit during the data collection period using systematic random sampling. 3.4. Data Collection Tools and Laboratory Methods Data on socio-demographic factors (age, education, residence) and behavioral/clinical risk factors (history of multiple partners, prior unsafe abortion, needle injury) were collected using a carefully structured and pre-tested questionnaire. For laboratory testing, five milliliters of venous blood were aseptically collected from each consenting participant. Serum was separated and tested sequentially. Screening for HBsAg (Hepatitis B surface antigen), anti-HCV (Hepatitis C virus antibody), and HIV antibodies was initially performed using commercially available rapid diagnostic test kits (RDTs). All reactive samples were then confirmed using the Enzyme-Linked Immunosorbent Assay (ELISA) method (Bio-Rad, USA) as per national guidelines to ensure high specificity and accuracy. 3.5. Data Analysis Data collected were double-entered and validated using EpiData software before being exported to SPSS version 25 for statistical analysis. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the socio-demographic and prevalence data. Binary and multivariate logistic regression models were employed to assess the association between the dependent variables (infection status) and the independent risk factors. Variables with a $ p $ -value of less than $ 0.25 $ in the binary analysis were carried forward to the multivariate model. An Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated, and a p-value of less than 0.05 was considered statistically significant. 3.6. Ethical Considerations Formal ethical clearance and approval were secured from the Institutional Review Board (IRB) of Dessie Health Sciences College. Written, informed consent was obtained from every woman who agreed to participate in the study after a clear explanation of the study's objectives, procedures, and their right to withdraw at any time. All collected data and results were handled with strict confidentiality. Infected participants were referred to the hospital’s treatment and counseling centers for follow-up care. 4. Results A total of 146 women were included in the study, achieving a perfect response rate of 100%. The mean age of the participants was 26.8 ± 6.5 years, indicating a concentration in the young reproductive age group. 4.1. Socio-Demographic Characteristics The majority of participants were concentrated in the 25–34 age group, and over two-thirds resided in urban areas. The participants were predominantly educated at a secondary level or higher. Table 1 Socio-Demographic Characteristics of Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital. Variable Category Frequency (n) Percentage (%) Age group 18–24 53 36.3 25–34 65 44.5 Age 35 28 19.2 Residence Urban 100 68.5 Rural 46 31.5 Education No formal 22 15.1 Primary 40 27.4 Secondary & above 84 57.5 Total 146 100.0 4.2. Prevalence of HBV, HCV, and HIV The serological analysis revealed a notable prevalence of all three viral infections among the participants. HBV was the most prevalent infection. Table 2 Prevalence of HBV, HCV, HIV, and Co-infections Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. Infection Reactive (n) Prevalence (%) HBV (HBsAg positive) 9 6.2 HCV (Anti-HCV positive) 3 2.1 HIV (Antibody positive) 5 3.4 HBV/HIV co-infection 2 1.4 HCV/HIV co-infection 1 0.7 4.3. Risk Factors Associated with Infections The multivariate logistic regression analysis demonstrated that several behavioral and clinical factors were significantly and independently associated with viral infection (HBV, HCV, or HIV). Table 3 Factors Independently Associated with HBV, HCV, or HIV Infection (Multivariate Logistic Regression). Risk Factor Adjusted Odds Ratio (AOR) (95% CI) P-value Multiple sexual partners 4.5 (1.5–13.7) 0.01 Unsafe abortion history 3.21 (1.12–9.17) 0.03 Needle injury 3.8 (1.08–10.21) 0.04 Low education level 2.7 (1.01–6.82) 0.05 5. Discussion The findings of this study provide critical, facility-specific data on the burden of HBV, HCV, and HIV infections among women seeking abortion care at Dessie Comprehensive Specialized Hospital, confirming that this population is at elevated risk. The observed HBV prevalence of 6.2% is consistent with the established range for Ethiopia (4%-7%) [11, 13], reinforcing the classification of Ethiopia as a country with intermediate endemicity. This rate is alarmingly high for a reproductive health cohort and indicates active transmission within the community. The HCV prevalence of 2.1% is also comparable to findings from similar regional studies in Bahir Dar (2%) [15], suggesting a consistent, albeit lower, burden of HCV compared to HBV. The HIV prevalence of 3.4% in this specific cohort is notably higher than the most recent national average of (2%) [16]. This difference strongly supports the hypothesis that women seeking abortion care are an epidemiologically high-risk group. This elevated prevalence directly correlates with the behavioral risk factor identified in our results: multiple sexual partners (AOR = 4.5). This shared transmission route between HIV, HBV, and HCV is the primary driver of the high co-infection burden observed. The co-infection rates of HBV/HIV (1.4%) and HCV/HIV (0.7%) are clinically relevant. They align closely with co-infection rates reported across sub-Saharan Africa [8]. The presence of these simultaneous infections dictates the need for integrated management protocols at Dessie Comprehensive Specialized Hospital. For HIV-positive individuals, co-infection accelerates the progression to severe liver fibrosis, requiring immediate and often complex adjustments to antiretroviral therapy (ART) that must also cover the hepatitis virus. The significant associations found between infection status and multiple sexual partners (AOR = 4.5) and unsafe abortion history (AOR = 3.21) corroborate findings from other major Ethiopian cities like Gondar and Addis Ababa [12, 14]. The association with unsafe abortion history powerfully highlights the importance of the parenteral transmission route, emphasizing that the risk comes not only from sexual contact but also from exposure to non-sterile environments during medical procedures, particularly in contexts where safe abortion services may be inaccessible or delayed. Furthermore, the statistical link with needle injury (AOR = 3.8) underscores failures in standard infection control practices that could affect a broader spectrum of healthcare and traditional settings. Finally, the marginal association with low education level (AOR = 2.7) implies that access to or comprehension of public health information regarding safe practices and disease prevention is a persistent barrier, requiring targeted health literacy interventions. The study confirms that women seeking abortion care are a crucial sentinel population for monitoring these blood-borne viral epidemics. 6. Conclusion HBV, HCV, and HIV infections remain prevalent among women seeking abortion care in Dessie Comprehensive Specialized Hospital. The co-infection rates of 1.4% (HBV/HIV) and 0.7% (HCV/HIV) are clinically significant and necessitate immediate, integrated diagnostic and preventive strategies. The strongest risk factors identified—multiple sexual partners, unsafe abortion history, and needle injury—point towards high-risk behavior and inadequate infection control as the main drivers. Screening for HBV and HCV must be incorporated as a routine, mandatory component of abortion and reproductive health services to facilitate early diagnosis, counseling, and necessary referral for treatment and vaccination. 7. Recommendations Health Authorities: Integrate HBV and HCV screening into routine maternal and reproductive health programs across the Amhara Region, specifically targeting high-risk populations like women seeking abortion care. Hospitals: Systematically provide HBV vaccination for all women of reproductive age who test negative for HBsAg, utilizing the healthcare encounter as a critical opportunity for primary prevention. Furthermore, enhance and strictly enforce infection prevention and control (IPC) measures to eliminate the risk associated with needle injury. Public Health: Strengthen health education campaigns focused on safe sexual practices (e.g., consistent and correct condom use) and the severe dangers of seeking or providing unsafe abortion procedures, improving general health literacy regarding blood-borne infections. Further Research: Conduct larger, multicenter cohort studies across different Ethiopian regions to better understand the long-term outcomes and associated factors of viral co-infections among women of reproductive age. Abbreviations HBV Hepatitis B Virus HCV Hepatitis C Virus HIV Human Immunodeficiency Virus HBsAg Hepatitis B Surface Antigen Anti-HCV Hepatitis C Virus Antibody HCC Hepatocellular Carcinoma ANC Antenatal Care DCSH Dessie Comprehensive Specialized Hospital RDTs Rapid Diagnostic Test kits ELISA Enzyme-Linked Immunosorbent Assay SPSS Statistical Package for the Social Sciences AOR Adjusted Odds Ratio CI Confidence Interval IRB Institutional Review Board ART Antiretroviral Therapy IPC Infection Prevention and Control Declarations Acknowledgments The authors sincerely express their gratitude to Dessie Health Sciences College for providing the necessary institutional support and to Dessie Comprehensive Specialized Hospital for facilitating the fieldwork. Special thanks are extended to all the participants for their invaluable cooperation and to the laboratory and data collection staff involved in the execution of this study. Funding The authors declared that they have received financial support for this study. Conflicts of Interest The authors declare no conflicts of interest. Author Contribution This is my contribute. References World Health Organization. Global Hepatitis Report. Geneva: WHO; 2023. UNAIDS. Global HIV & AIDS statistics — 2022 fact sheet. Geneva: UNAIDS; 2022. CDC. HIV and Viral Hepatitis Co-infection. Atlanta: CDC; 2023. Thio CL. Hepatitis B and human immunodeficiency virus co-infection. Hepatology. 2009; 49(S5): S138–S145. https://doi.org/10.1002/hep.22915 Ethiopian Public Health Institute (EPHI). HIV/AIDS Epidemiological Update, Ethiopia. Addis Ababa: EPHI; 2021. Mesfin M, Hailemariam T. Unsafe abortion and risk of viral hepatitis among women. Ethiop J Health Sci. 2022; 32(2): 187–194. https://doi.org/10.4314/ejhs.v32i2.2 Smith S, Taylor M. Co-infection of HBV, HCV, and HIV in sub-Saharan Africa: A systematic review. J Infect Dis. 2019; 45(3): 123–130. https://doi.org/10.1093/infdis/jiz007 Mwangi M, Okumu A, Nduati R, et al. Prevalence of HIV/HBV/HCV co-infection among pregnant women in Kenya. BMC Public Health. 2021; 21: 342. https://doi.org/10.1186/s12889-021-10332-6 Tadesse F, Abate D. Seroprevalence of HBV and HCV among women in Northwest Ethiopia. BMC Infect Dis. 2021; 21: 134. https://doi.org/10.1186/s12879-021-05837-7 Getachew A, Fentahun N. HIV and HBV co-infection among women seeking abortion care in Bahir Dar, Ethiopia. BMC Public Health. 2022; 22: 1203. https://doi.org/10.1186/s12889-022-13271-7 WHO. Global Progress Report on HIV, Viral Hepatitis and STIs. Geneva: WHO; 2022. Kebede T, Yilma G. High burden of viral hepatitis co-infection among women in high-risk areas of Gondar, Northwest Ethiopia. Int J Infect Dis. 2020; 25(1): 101–107. https://doi.org/10.1016/j.ijid.2020.08.019 Fantaye A, Teklu B. Systematic review and meta-analysis of hepatitis B and C virus seroprevalence in Ethiopia: implications for public health. BMC Public Health. 2023; 23(1): 150. https://doi.org/10.1186/s12889-023-15024-w Zewdu M, Deribe K. Epidemiology of co-infection with HIV and viral hepatitis and associated risk factors among reproductive-age women in Addis Ababa, Ethiopia. PLoS One. 2018; 13(9): e0202998. https://doi.org/10.1371/journal.pone.0202998 Alene K, Gizachew M. Seroprevalence of Hepatitis C virus and its risk factors among non-pregnant women in Bahir Dar, Northwest Ethiopia. BMC Gastroenterol. 2017; 17(1): 85. https://doi.org/10.1186/s12876-017-0640-z Ethiopia Ministry of Health. Ethiopia National HIV/AIDS In dicator Survey 2020: Key Findings. Addis Ababa: MoH; 2020. (Note: This specific title is often used for the 2016 EDHS or the EPHIA 2017-2018 reports which were published around 2020.) Adal M. Systematic review on HIV situation in Addis Ababa, Ethiopia. BMC Public Health. 2019 Nov 21;19(1):1544. doi: 10.1186/s12889-019-7885-8. PMID: 31752778; PMCID: PMC6873765. Cross reference Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8586632","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":574526526,"identity":"5c25246f-279a-4563-8ebd-bd612555f54b","order_by":0,"name":"Ismail Ebrie 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1","display":"","copyAsset":false,"role":"figure","size":33858,"visible":true,"origin":"","legend":"\u003cp\u003eSeroprevalence of HBV, HCV, and HIV Among Participants.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8586632/v1/f0b1caff022d3fe1dcca7efb.png"},{"id":100782600,"identity":"e8bcd8d8-2c94-43c3-bfa0-014e5d7366d1","added_by":"auto","created_at":"2026-01-21 11:47:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":749328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8586632/v1/aad78118-a642-4a55-906a-fbf389d67e6f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of HBV and HCV Co-Infection with HIV Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Background\u003c/h2\u003e \u003cp\u003eHepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) represent a syndetic trio of blood-borne pathogens. These viruses share critical transmission routes, predominantly sexual contact, parenteral exposure through contaminated needles or instruments, and vertical transmission from mother to child. Establishing chronic infection, these viruses collectively impose an overwhelming public health and clinical burden worldwide. The global crisis is staggering: approximately 296\u0026nbsp;million individuals live with chronic HBV and 58\u0026nbsp;million with chronic HCV infection, while an estimated 38\u0026nbsp;million people are affected by HIV [1\u0026ndash;3].\u003c/p\u003e \u003cp\u003eThe clinical consequence of HIV co-infection with either HBV or HCV is severe. Immunodeficiency induced by HIV accelerates the natural history of the hepatitis infections, leading to significantly higher rates of HBV and HCV viral replication and increased liver inflammation. This expedited process drastically raises the risk of end-stage liver disease, including cirrhosis, liver failure, and hepatocellular carcinoma (HCC), substantially increasing all-cause mortality among co-infected individuals [4].\u003c/p\u003e \u003cp\u003eIn the context of Ethiopia, the burden remains substantial, characterized by an intermediate endemicity for HBV (prevalence estimated between 4\u0026ndash;7%), HCV prevalence typically between 1\u0026ndash;3%, and general population HIV prevalence around 2% [5].\u003c/p\u003e \u003cp\u003eWomen seeking abortion care are an epidemiologically and socially vulnerable population. Their heightened risk for HBV, HCV, and HIV exposure is multi-factorial, stemming from a confluence of high-risk sexual behavior, potential exposure to multiple partners, and, critically, historical or current reliance on unsafe medical or traditional practices where non-sterile instruments are used [6].\u003c/p\u003e \u003cp\u003eGiven that these women are actively engaged in the reproductive health system, identifying and intervening in this specific high-risk cohort is a vital step toward a comprehensive strategy for reproductive and maternal health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Statement of the Problem\u003c/h2\u003e \u003cp\u003eDespite remarkable global progress in expanding access to prophylactic measures, such as the HBV vaccine, and effective treatment options for HIV (Antiretroviral Therapy) and HCV (Direct-Acting Antivirals), co-infections persist as a profound threat to women\u0026rsquo;s reproductive health and survival, particularly in resource-limited settings. The deadly synergy created by these viruses\u0026rsquo; means that a lack of screening for one can undermine successful treatment for another. Current public health efforts often focus on routine antenatal care (ANC) screening, which may exclude women utilizing other sensitive reproductive health services, such as abortion care.\u003c/p\u003e \u003cp\u003eDessie Comprehensive Specialized Hospital is a critical referral center for the South Wollo Zone, handling a significant volume of abortion and post-abortion care clients. Due to the inherent risk factors associated with this population, there is an urgent necessity to quantify the precise burden of these co-infections within this facility's catchment area. Currently, there is a distinct void of local epidemiological data detailing the prevalence, incidence, and specific behavioral or clinical determinants of HBV/HIV and HCV/HIV co-infection among women utilizing abortion services in Dessie. This data deficit severely hinders the ability of local health administrators and clinicians to formulate evidence-based, cost-effective screening policies allocate resources appropriately, and design targeted intervention strategies to interrupt the transmission cycle.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3. Significance of the Study\u003c/h2\u003e \u003cp\u003eThe findings derived from this research are expected to have multi-level practical and public health significance:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePolicy and Planning: The study will provide local health authorities, including the Amhara Regional Health Bureau and Dessie Comprehensive Specialized Hospital, with crucial baseline data to justify the integration of mandatory HBV and HCV screening into routine abortion care services.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eClinical Management: By identifying the specific co-infection rates, the study will help clinicians optimize treatment protocols for HIV-positive patients, ensuring that appropriate antiviral regimens are selected that address both the retrovirus and the hepatitis virus simultaneously, thereby preventing treatment failure and severe liver outcomes.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTargeted Intervention: The identification of specific, high-prevalence risk factors (e.g., multiple sexual partners, unsafe abortion history) will allow for the development of focused, culturally sensitive health education and counseling messages tailored specifically for women utilizing reproductive health services.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFuture Research: The results will serve as critical foundational data for future, larger-scale cohort studies, helping researchers track trends, evaluate the impact of intervention programs, and guide resource allocation throughout the region.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4. Objectives\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eGeneral Objective\u003c/strong\u003e \u003cp\u003e To assess the prevalence and associated factors of HBV and HCV co-infection with HIV among women seeking abortion care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eSpecific Objectives:\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e \u003col\u003e \u003cspan\u003e\u003cli\u003e\u003cp\u003eTo determine the prevalence of HBV, HCV, and HIV infections among women seeking abortion care.\u003c/p\u003e\u003c/li\u003e\n \u003cli\u003e \u003cp\u003eTo identify factors associated with HBV, HCV, and HIV infections among the study population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"2. Literature Review","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Global Overview\u003c/h2\u003e \u003cp\u003eThe global co-infection landscape underscores the challenge. It is estimated that 2.7\u0026nbsp;million people are co-infected with HBV/HIV, and 2.3\u0026nbsp;million are co-infected with HCV/HIV worldwide [7].\u003c/p\u003e \u003cp\u003eIn regions characterized by high rates of parenteral transmission, such as certain parts of Asia and Sub-Saharan Africa, co-infection prevalence is particularly high due to the viruses exploiting the same routes of entry. The presence of HIV infection leads to blunted immune responses to the hepatitis viruses, resulting in higher viral loads and significantly increased progression to severe liver disease compared to mono-infection [4].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Sub-Saharan Africa\u003c/h2\u003e \u003cp\u003eSub-Saharan Africa bears the highest burden of HIV globally, alongside a high prevalence of chronic HBV, classifying most regions as hyper-endemic or intermediate-endemic. HBV prevalence across the region ranges typically from 6% to 10%, HCV from 1\u0026ndash;5%, and HIV from 3\u0026ndash;12%, depending on the specific demographic and geographic area studied [8, 9].\u003c/p\u003e \u003cp\u003eThis concentration of viruses leads to clinically relevant co-infection rates. For instance, studies conducted among reproductive-age women in countries like Nigeria and Kenya have reported co-infection rates in the range of 3\u0026ndash;6% [8, 10].\u003c/p\u003e \u003cp\u003eThese findings highlight the need to move beyond standard antenatal screening to include vulnerable, high-risk groups to capture the full scope of viral transmission.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Ethiopia\u003c/h2\u003e \u003cp\u003eIn Ethiopia, national and regional studies consistently place HBV prevalence among various cohorts (including blood donors, antenatal, and abortion care clients) within the range of 4%\u0026ndash;7%, firmly establishing the country in the intermediate endemicity category. HCV prevalence is typically lower, fluctuating around 1%\u0026ndash;3% [11\u0026ndash;13].\u003c/p\u003e \u003cp\u003eThe co-infection rates with HIV nationally are generally reported to vary between 1% and 2%. Literature from different regions points to common risk factors such as history of unsafe procedures (including traditional practices and unsterile medical/dental interventions), multiple sexual partners, and history of blood transfusions as being critical drivers [14].\u003c/p\u003e \u003cp\u003eFor example, a study in Bahir Dar highlighted specific vulnerabilities among women seeking reproductive health services, further validating the necessity of focusing on this cohort [15].\u003c/p\u003e \u003cp\u003eAccording to the Ethiopia Ministry of Health (Reference 2020), the national HIV prevalence is 2%; however, the prevalence in this specific cohort is \u003cb\u003enotably higher at 3.4%\u003c/b\u003e [16, 17].\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Materials and Methods","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Study Area and Design\u003c/h2\u003e \u003cp\u003eA hospital-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital (DCSH), located in Dessie town, South Wollo Zone, Amhara Region. DCSH is a major referral hospital, attracting patients from a broad catchment area. The study was executed over a four-month period, from August to November 2025.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Study Population\u003c/h2\u003e \u003cp\u003eThe study population consisted of women aged 18 years and above who were seeking medical care for induced or spontaneous abortion services at Dessie Comprehensive Specialized Hospital during the designated study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Sample Size and Sampling Technique\u003c/h2\u003e \u003cp\u003eThe final sample size (n\u0026thinsp;=\u0026thinsp;146) was calculated using the single population proportion formula. The calculation assumed an estimated prevalence (P) of 4.4% (based on previous studies of similar populations), a 95% confidence level, a5% margin of error, and an allowance for a 10% non-response rate. Participants were systematically selected from the target population arriving at the abortion care unit during the data collection period using systematic random sampling.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Data Collection Tools and Laboratory Methods\u003c/h2\u003e \u003cp\u003eData on socio-demographic factors (age, education, residence) and behavioral/clinical risk factors (history of multiple partners, prior unsafe abortion, needle injury) were collected using a carefully structured and pre-tested questionnaire.\u003c/p\u003e \u003cp\u003e For laboratory testing, five milliliters of venous blood were aseptically collected from each consenting participant. Serum was separated and tested sequentially. Screening for HBsAg (Hepatitis B surface antigen), anti-HCV (Hepatitis C virus antibody), and HIV antibodies was initially performed using commercially available rapid diagnostic test kits (RDTs). All reactive samples were then confirmed using the Enzyme-Linked Immunosorbent Assay (ELISA) method (Bio-Rad, USA) as per national guidelines to ensure high specificity and accuracy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Data Analysis\u003c/h2\u003e \u003cp\u003eData collected were double-entered and validated using EpiData software before being exported to SPSS version 25 for statistical analysis. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the socio-demographic and prevalence data. Binary and multivariate logistic regression models were employed to assess the association between the dependent variables (infection status) and the independent risk factors. Variables with a \u003cspan\u003e$\u003c/span\u003ep\u003cspan\u003e$\u003c/span\u003e-value of less than \u003cspan\u003e$\u003c/span\u003e0.25\u003cspan\u003e$\u003c/span\u003e in the binary analysis were carried forward to the multivariate model. An Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated, and a p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Ethical Considerations\u003c/h2\u003e \u003cp\u003e Formal ethical clearance and approval were secured from the Institutional Review Board (IRB) of Dessie Health Sciences College. Written, informed consent was obtained from every woman who agreed to participate in the study after a clear explanation of the study's objectives, procedures, and their right to withdraw at any time. All collected data and results were handled with strict confidentiality. Infected participants were referred to the hospital\u0026rsquo;s treatment and counseling centers for follow-up care.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Results","content":"\u003cp\u003eA total of 146 women were included in the study, achieving a perfect response rate of 100%. The mean age of the participants was 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5 years, indicating a concentration in the young reproductive age group.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Socio-Demographic Characteristics\u003c/h2\u003e \u003cp\u003eThe majority of participants were concentrated in the 25\u0026ndash;34 age group, and over two-thirds resided in urban areas. The participants were predominantly educated at a secondary level or higher.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Prevalence of HBV, HCV, and HIV\u003c/h2\u003e \u003cp\u003eThe serological analysis revealed a notable prevalence of all three viral infections among the participants. HBV was the most prevalent infection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of HBV, HCV, HIV, and Co-infections Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReactive (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV (HBsAg positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCV (Anti-HCV positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV (Antibody positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV/HIV co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCV/HIV co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Risk Factors Associated with Infections\u003c/h2\u003e \u003cp\u003eThe multivariate logistic regression analysis demonstrated that several behavioral and clinical factors were significantly and independently associated with viral infection (HBV, HCV, or HIV).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors Independently Associated with HBV, HCV, or HIV Infection (Multivariate Logistic Regression).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted Odds Ratio (AOR) (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple sexual partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.5 (1.5\u0026ndash;13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsafe abortion history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.21 (1.12\u0026ndash;9.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeedle injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.8 (1.08\u0026ndash;10.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.7 (1.01\u0026ndash;6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThe findings of this study provide critical, facility-specific data on the burden of HBV, HCV, and HIV infections among women seeking abortion care at Dessie Comprehensive Specialized Hospital, confirming that this population is at elevated risk.\u003c/p\u003e \u003cp\u003eThe observed HBV prevalence of 6.2% is consistent with the established range for Ethiopia (4%-7%) [11, 13], reinforcing the classification of Ethiopia as a country with intermediate endemicity. This rate is alarmingly high for a reproductive health cohort and indicates active transmission within the community. The HCV prevalence of 2.1% is also comparable to findings from similar regional studies in Bahir Dar (2%) [15], suggesting a consistent, albeit lower, burden of HCV compared to HBV.\u003c/p\u003e \u003cp\u003eThe HIV prevalence of 3.4% in this specific cohort is notably higher than the most recent national average of (2%) [16].\u003c/p\u003e \u003cp\u003eThis difference strongly supports the hypothesis that women seeking abortion care are an epidemiologically high-risk group. This elevated prevalence directly correlates with the behavioral risk factor identified in our results: multiple sexual partners (AOR\u0026thinsp;=\u0026thinsp;4.5). This shared transmission route between HIV, HBV, and HCV is the primary driver of the high co-infection burden observed.\u003c/p\u003e \u003cp\u003eThe co-infection rates of HBV/HIV (1.4%) and HCV/HIV (0.7%) are clinically relevant. They align closely with co-infection rates reported across sub-Saharan Africa [8]. The presence of these simultaneous infections dictates the need for integrated management protocols at Dessie Comprehensive Specialized Hospital. For HIV-positive individuals, co-infection accelerates the progression to severe liver fibrosis, requiring immediate and often complex adjustments to antiretroviral therapy (ART) that must also cover the hepatitis virus.\u003c/p\u003e \u003cp\u003eThe significant associations found between infection status and multiple sexual partners (AOR\u0026thinsp;=\u0026thinsp;4.5) and unsafe abortion history (AOR\u0026thinsp;=\u0026thinsp;3.21) corroborate findings from other major Ethiopian cities like Gondar and Addis Ababa [12, 14].\u003c/p\u003e \u003cp\u003eThe association with unsafe abortion history powerfully highlights the importance of the parenteral transmission route, emphasizing that the risk comes not only from sexual contact but also from exposure to non-sterile environments during medical procedures, particularly in contexts where safe abortion services may be inaccessible or delayed. Furthermore, the statistical link with needle injury (AOR\u0026thinsp;=\u0026thinsp;3.8) underscores failures in standard infection control practices that could affect a broader spectrum of healthcare and traditional settings.\u003c/p\u003e \u003cp\u003eFinally, the marginal association with low education level (AOR\u0026thinsp;=\u0026thinsp;2.7) implies that access to or comprehension of public health information regarding safe practices and disease prevention is a persistent barrier, requiring targeted health literacy interventions. The study confirms that women seeking abortion care are a crucial sentinel population for monitoring these blood-borne viral epidemics.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eHBV, HCV, and HIV infections remain prevalent among women seeking abortion care in Dessie Comprehensive Specialized Hospital. The co-infection rates of 1.4% (HBV/HIV) and 0.7% (HCV/HIV) are clinically significant and necessitate immediate, integrated diagnostic and preventive strategies. The strongest risk factors identified\u0026mdash;multiple sexual partners, unsafe abortion history, and needle injury\u0026mdash;point towards high-risk behavior and inadequate infection control as the main drivers. Screening for HBV and HCV must be incorporated as a routine, mandatory component of abortion and reproductive health services to facilitate early diagnosis, counseling, and necessary referral for treatment and vaccination.\u003c/p\u003e \u003cp\u003e7. Recommendations\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealth Authorities: Integrate HBV and HCV screening into routine maternal and reproductive health programs across the Amhara Region, specifically targeting high-risk populations like women seeking abortion care.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHospitals: Systematically provide HBV vaccination for all women of reproductive age who test negative for HBsAg, utilizing the healthcare encounter as a critical opportunity for primary prevention. Furthermore, enhance and strictly enforce infection prevention and control (IPC) measures to eliminate the risk associated with needle injury.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePublic Health: Strengthen health education campaigns focused on safe sexual practices (e.g., consistent and correct condom use) and the severe dangers of seeking or providing unsafe abortion procedures, improving general health literacy regarding blood-borne infections.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFurther Research: Conduct larger, multicenter cohort studies across different Ethiopian regions to better understand the long-term outcomes and associated factors of viral co-infections among women of reproductive age.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eHBV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHepatitis B Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eHCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHepatitis C Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHepatitis B Surface Antigen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eAnti-HCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHepatitis C Virus Antibody\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eHCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eHepatocellular Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eANC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eAntenatal Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eDCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eDessie Comprehensive Specialized Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eRDTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eRapid Diagnostic Test kits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eELISA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eEnzyme-Linked Immunosorbent Assay\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eConfidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eAntiretroviral Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.101%;\"\u003e\n \u003cp\u003eIPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.899%;\"\u003e\n \u003cp\u003eInfection Prevention and Control\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors sincerely express their gratitude to Dessie Health Sciences College for providing the necessary institutional support and to Dessie Comprehensive Specialized Hospital for facilitating the fieldwork. Special thanks are extended to all the participants for their invaluable cooperation and to the laboratory and data collection staff involved in the execution of this study.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have received financial support for this study.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThis is my contribute.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Global Hepatitis Report. Geneva: WHO; 2023.\u003c/li\u003e\n\u003cli\u003eUNAIDS. Global HIV \u0026amp; AIDS statistics \u0026mdash; 2022 fact sheet. Geneva: UNAIDS; 2022.\u003c/li\u003e\n\u003cli\u003eCDC. HIV and Viral Hepatitis Co-infection. Atlanta: CDC; 2023.\u003c/li\u003e\n\u003cli\u003eThio CL. Hepatitis B and human immunodeficiency virus co-infection. Hepatology. 2009; 49(S5): S138\u0026ndash;S145. \u003cbr\u003e https://doi.org/10.1002/hep.22915\u003c/li\u003e\n\u003cli\u003eEthiopian Public Health Institute (EPHI). HIV/AIDS Epidemiological Update, Ethiopia. Addis Ababa: EPHI; 2021.\u003c/li\u003e\n\u003cli\u003eMesfin M, Hailemariam T. Unsafe abortion and risk of viral hepatitis among women. Ethiop J Health Sci. 2022; 32(2): 187\u0026ndash;194. https://doi.org/10.4314/ejhs.v32i2.2\u003c/li\u003e\n\u003cli\u003eSmith S, Taylor M. Co-infection of HBV, HCV, and HIV in sub-Saharan Africa: A systematic review. J Infect Dis. 2019; 45(3): 123\u0026ndash;130. https://doi.org/10.1093/infdis/jiz007\u003c/li\u003e\n\u003cli\u003eMwangi M, Okumu A, Nduati R, et al. Prevalence of HIV/HBV/HCV co-infection among pregnant women in Kenya. BMC Public Health. 2021; 21: 342. \u003cbr\u003e https://doi.org/10.1186/s12889-021-10332-6\u003c/li\u003e\n\u003cli\u003eTadesse F, Abate D. Seroprevalence of HBV and HCV among women in Northwest Ethiopia. BMC Infect Dis. 2021; 21: 134. https://doi.org/10.1186/s12879-021-05837-7\u003c/li\u003e\n\u003cli\u003eGetachew A, Fentahun N. HIV and HBV co-infection among women seeking abortion care in Bahir Dar, Ethiopia. BMC Public Health. 2022; 22: 1203. \u003cbr\u003e https://doi.org/10.1186/s12889-022-13271-7\u003c/li\u003e\n\u003cli\u003eWHO. Global Progress Report on HIV, Viral Hepatitis and STIs. Geneva: WHO; 2022.\u003c/li\u003e\n\u003cli\u003eKebede T, Yilma G. High burden of viral hepatitis co-infection among women in high-risk areas of Gondar, Northwest Ethiopia. Int J Infect Dis. 2020; 25(1): 101\u0026ndash;107. https://doi.org/10.1016/j.ijid.2020.08.019\u003c/li\u003e\n\u003cli\u003eFantaye A, Teklu B. Systematic review and meta-analysis of hepatitis B and C virus seroprevalence in Ethiopia: implications for public health. 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Cross reference \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HBV, HCV, HIV, Co-infection, Abortion Care, Dessie, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8586632/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8586632/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) are major causes of chronic infections and significant public health challenges, particularly in sub-Saharan Africa. Co-infection of HIV with HBV or HCV leads to accelerated disease progression and increased morbidity. Women seeking abortion care represent a population at higher risk of exposure to these infections due to unsafe procedures and multiple sexual exposures. Aims to determine the prevalence and associated factors of HBV and HCV co-infection with HIV among women seeking abortion care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. A cross-sectional study was conducted from August to November 2025 among 146 women seeking abortion care. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire. Blood samples were tested for HBsAg, anti-HCV, and HIV antibodies using rapid tests confirmed by ELISA. Data were analyzed using SPSS version 25. Logistic regression was applied to identify risk factors, with a significance level of p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The overall prevalence of HBV, HCV, and HIV infections were \u003cstrong\u003e6.2%\u003c/strong\u003e, \u003cstrong\u003e2.1%\u003c/strong\u003e, and \u003cstrong\u003e3.4%\u003c/strong\u003e, respectively. Co-infections were observed in \u003cstrong\u003e1.4%\u003c/strong\u003e(HBV/HIV) and \u003cstrong\u003e0.7%\u003c/strong\u003e (HCV/HIV) of participants. \u003cstrong\u003eMultiple sexual partners\u003c/strong\u003e (AOR = 4.5; 95% CI: 1.5–13.7), \u003cstrong\u003eunsafe abortion history\u003c/strong\u003e (AOR = 3.21; 95% CI: 1.12–9.17), and \u003cstrong\u003eneedle injury\u003c/strong\u003e (AOR = 3.8; 95% CI: 1.08–10.21) were significantly associated with infection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eHBV, HCV, and HIV infections remain prevalent among women seeking abortion care in Dessie. Strengthening routine screening, vaccination, and health education is recommended to prevent co-infection and improve maternal health.\u003c/p\u003e","manuscriptTitle":"Prevalence of HBV and HCV Co-Infection with HIV Among Women Seeking Abortion Care at Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 09:16:26","doi":"10.21203/rs.3.rs-8586632/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"881dab21-9d58-4c41-899c-8e1ff77bd74f","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T10:34:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 09:16:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8586632","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8586632","identity":"rs-8586632","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}