Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study

Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study | 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 Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study Felix Ayornu, Jacob Tetteh Agbezuke, Stephen Gyenin, Ebenezer Senu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8414449/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 : Sexually transmitted infections (STIs) remain a major public health burden in low- and middle-income countries, particularly in sub-Saharan Africa where diagnostic limitations and asymptomatic infections contribute to under-reporting. However, in Ghana, data on the co-occurrence of HIV with other STIs in outpatient settings are limited. This study assessed the prevalence and co-infection patterns of HIV, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and gonorrhea among outpatients in the Greater Accra Region of Ghana. Methods: A retrospective cross-sectional study involving 1,578 outpatients was conducted at a primary healthcare facility between January and December 2024. Sociodemographic and laboratory data were extracted from the hospital information management system. Descriptive statistics summarized prevalence of HIV and other STIs. Chi-square tests and binary logistic regression were used to determine associations and predictors of HIV infection. A p-value < 0.05 was considered statistically significant. Results: Of the 1,578 participants, 54.9% were female, and most (50.5%) were aged 25–45 years. Overall HIV prevalence was 6.4%, while HBV, HCV, syphilis, and gonorrhea were 13.0%, 5.5%, 6.0%, and 15.6%, respectively. HIV–STI co-infection represented 2.0% of all HIV-positive cases. Age was significantly associated with HIV status (p = 0.002), with the highest positivity recorded among individuals >45 years. Logistic regression showed that participants aged 1–25 years (aOR = 0.30; 95% CI: 0.14–0.63; p 45 years. Gender and the presence of other STIs were not significantly associated with HIV positivity (p > 0.05). Conclusion: A considerable burden of HIV and other STIs was observed, with low but notable co-infection rates. Individuals older than 45 years were at highest risk of HIV infection. Strengthening integrated HIV/STI screening, promoting early diagnosis, and targeting age-specific health education particularly for older adults are critical to improving prevention and control strategies in Ghanaian outpatient settings. HIV sexually transmitted infections co-infection hepatitis B hepatitis C syphilis gonorrhea Ghana outpatient cohort cross-sectional study Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Sexually transmitted infections (STIs) remain major global public health concerns with severe medical, social, and economic implications. From ancient history to modern times, these infections have persisted across societies and geographical boundaries, disproportionately affecting vulnerable populations ( 1 ). Although more than 30 bacterial, viral, and parasitic pathogens are transmitted through sexual contact, the global burden is dominated by eight major infections—gonorrhea, syphilis, chlamydia, trichomoniasis, hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), herpes simplex virus (HSV), and HIV ( 2 ). While bacterial STIs such as chlamydia, gonorrhea, and syphilis are generally curable, the rapid emergence of antimicrobial resistance threatens treatment success and future disease control efforts ( 3 ). In response, the World Health Organization (WHO) set ambitious 2030 targets, including a 90% global reduction in Treponema pallidum and Neisseria gonorrhoeae incidence from 2018 baselines, highlighting the urgency of strengthened surveillance, integrated screening, and effective treatment ( 4 ). The transmission of HIV, syphilis, HBV, HCV, and gonorrhea is closely intertwined due to shared sexual, parenteral, and perinatal modes of spread. Sexual exposure remains the leading route, and co-existing genital ulcers or inflammation significantly increase susceptibility to HIV acquisition ( 5 ). Parenteral transmission, particularly among people who inject drugs, also contributes to high HIV/HBV/HCV co-infection rates worldwide ( 6 ), while untreated maternal infections contribute substantially to perinatal transmission and neonatal morbidity ( 7 ).These overlapping pathways amplify clinical complications; for example, syphilis accelerates HIV disease progression, while HIV–HBV or HIV–HCV co-infections lead to rapid liver fibrosis, cirrhosis, and higher non-AIDS mortality ( 8 ). Evidence from China and other high-burden regions shows elevated co-infection in HIV-positive populations, largely driven by overlapping risk behaviors and gaps in prevention and routine screening ( 6 ) Sub-Saharan Africa bears the highest global burden of STIs and viral hepatitis, worsened by limited diagnostic capacity, cost barriers, and delayed treatment. Chlamydia prevalence rose by 34.5% between 2010 and 2020, reaching 6.6% among females and 4.7% among males ( 9 ), while HIV-related immunosuppression fuels high rates of opportunistic viral and fungal infections ( 10 ). HCV prevalence averages 5.3% across Africa but exceeds 6% in Central Africa, with higher morbidity among HIV-positive individuals ( 11 , 12 ). A significant proportion of infections remain undiagnosed due to asymptomatic presentation, stigma, weak surveillance, and limited access to routine laboratory screening creating a persistent “silent burden.” Ghana reflects similar epidemiological patterns. Hepatitis B remains hyperendemic, with prevalence between 12.3% and 14.4% in the general population ( 13 ), and HCV prevalence averages 6.04%, ranging from 1.3% in the Central Region to 20.9% in the Northern Region ( 14 ). HIV/HBV co-infection is also substantial at 13.6% ( 15 ). In Southern Ghana, a recent study reported 24.7% STIs among symptomatic patients, dominated by gonorrhea, chlamydia, and syphilis, with 3.4% presenting multiple pathogens ( 16 ). Yet co-screening remains uncommon, and many facilities rely on syndromic management due to cost and limited diagnostic capacity, despite rising antimicrobial resistance. Although individual infections have been studied in Ghana, limited evidence describes their sero-epidemiological overlap in outpatient populations. Co-occurrence influences transmission dynamics, increases complications, and affects treatment decisions, but routine integrated screening is lacking. This study therefore maps the prevalence and co-occurrence of HIV, syphilis, HBV, HCV, and gonorrhea among outpatients in Ghana. Findings will provide baseline evidence to strengthen integrated STI surveillance, improve screening strategies, and inform policy interventions for prevention, early diagnosis, and effective clinical management. MATERIALS AND METHODS Study design and study site A retrospective cross-sectional design was used to study Sero-Epidemiological Prevalence and Co-occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea at the Mother of God Hospital (MOG) in the Greater Accra Region of Ghana. MOG is a primary hospital located in Ashaiman Lebanon- Ashaiman Municipal District, well-resourced and serving a population of about 8,000 annually. Study population The study involved all individuals who visited the hospital on normal Out patients Department (OPD) basis as well as those who had been admitted. Inclusion criteria Participants eligible for inclusion in this study where those who willingly gave informed consent, and for children, their parents gave accent for their participation in the study. Exclusion criteria Individuals who decline informed consent and those who did not express their willingness to participate in the study was not considered. Sample size calculation and sampling technique The sample size for the study was determined using the Cochran’s formula: \(\:n=\frac{{z}^{2}pq}{{e}^{2}}\) ; where: n is the minimum sample size, p is the prevalence of HIV in Ghana = 1.7% ( 17 ), q = 1-p, (98.3), z = z value at 95% confidence (1.96), and e is the margin of error (0.05). This gave minimum of twenty-six ( 26 ) participants required for the study. To increase representativeness and statistical power, one thousand, five hundred and seventy-eight (1,578) were included in the study. Ethical consideration Approval was obtained from the management of Mother of God Hospital before the commencement of the study. Also, the confidentiality and anonymity of the study participants were ensured by data collected and coded using IDs and none of the data were required to add personal information. The study was conducted following the guidelines of the Helsinki declaration. Data collection Data for this study was retrospectively extracted from the Hospital Information Management System (HMIS). The dataset contained anonymized records of outpatients and inpatient who visited the hospital between January and December 2024. Extracted variables included sociographic information (age and gender) as well as clinical data (test results for HIV, Hepatitis B surface antigen, Hepatitis C antibody, Syphilis and Gonorrhea).To ensure accuracy, the extracted data were cross-checked against laboratory registers and cleaned to removed duplicates, incomplete record and inconsistencies. Data management and analysis Data collected were entered into Microsoft Office Excel 2021, cleaned, coded and exported into the Statistical Package for Social Sciences version 26.0 (SPSS, Inc.; Chicago, IL, USA) and analyzed. GraphPad Prism 8.0 was used to plot all graphs. Categorical variables were presented as frequencies and percentages after performing descriptive statistics. Bar charts were used to illustrate the prevalence of HIV, HBsAg, HCV, Syphilis and Gonorrhea. Pearson chi-square test and Logistic regression were used to determine the association and predictors of HIV coinfection. p - value of less that 0.005 and 95% confidence interval were considered statistically significant. RESULTS Sociodemographic characteristics of study participants A total of 1,578 participants were included in this study, comprising 708 males (44.9%) and 866 female (54.9%). The majority of participants were withing the 25–45-year age group (50.5%), followed by those aged 1–25 years (26.0%) and then > 45 years (21.9%) (Table 1 ). Table 1 Sociodemographic Characteristics of participants Age Group Frequency (n) Percentage (%) Total 1578 100.0 Age group (yrs) 1–25 411 26.0 25–45 797 50.5 > 45 345 21.9 Gender Male 708 44.9 Female 866 54.9 Data presented as frequency and percentage Prevalence of HIV and Other Sexually Transmitted Infections The overall prevalence of HIV among the study population was 6.4%. Hepatitis B surface antigen (HBsAg) positivity was observed in 13.0% of those tested. Syphilis recorded a prevalence of 6.0%.Gonorrea showed a prevalence of 15.6% while the least prevalence was recorded in Hepatitis C virus; 5.5%. Coinfections with HIV and another STI was rare, accounting for only 2.0% of all HIV-positive participants (Fig. 1 – 6 ). Association Between HIV status and Sociodemographic Factors Table 2 presents the bivariate associations between HIV infection and participants’ characteristics. A significant association was observed between age and HIV positivity (p 45 years, compared to 15.5% in the 1–25-year age group. Gender was not significantly associated with HIV infection (p = 0.177), although females (62%) had higher HIV prevalence than males (38%). No significant associations were observed between HIV and other STIs (HBsAg, HCV, syphilis, or gonorrhea), all with p-values > 0.05 (Table 2 ). Table 2 Association between HIV and participants sociodemographic as well as other STIs Variable HIV-Negative [n(%)] HIV-Positive[n(%)] p -value Total 1477(93.60) 101(6.40) Age Group 45 308(21.20) 37(38.10) Gender 0.177 Male 670(45.50) 38(38.00) Female 804(54.50) 62(62.00) VDRL 1.000 Reactive 16(5.60) 0(0.00) Non-Reactive 270(94.40) 11(100.00) HBsAg 0.215 Positive 14(6.80) 2(16.70) Negative 193(93.20) 10(83.30) HCV 1.000 Positive 2(3.90) 0(0.0) Negative 49(96.10) 2(100.0) Gonorrhea 1.000 Positive 20(18.20) 0(0.0) Negative 90(81.80) 2(100.0) p -values computed by Chi-squared/Fisher’ s exact test. p -value < 0.05 was considered statistically significant Logistic Regression Analysis of Factors Associated with HIV Positivity Binary logistic regression identified age as a significant predictor of HIV infection. Participants aged 1–25 years had lower odds of being HIV-positive compared to those aged > 45 years (cOR = 0.32; 95% CI: 0.17–0.59; p < 0.001). Those aged 25–45 years also had reduced odds (cOR = 0.50; 95% CI: 0.32–0.79; p = 0.003). After adjustment for confounders, the associations were not statistically significant (aOR = 0.88; 95% CI: 0.16–4.92; p = 0.881 for 1–25 years; aOR = 0.45; 95% CI: 0.10–2.02; p = 0.296). Gender showed no significant association with HIV positivity after adjustment (aOR = 1.60; 95% CI: 0.47–5.47; p = 0.456). HBsAg-positive participants were more likely to be HIV-positive (aOR = 2.96; 95% CI: 0.55–15.99; p = 0.208), though not statistically significant (Table 3 ). Table 3 Logistic Regression Analysis of Factors Associated with HIV Positivity Among Study Participants Variable Positive [n(%)] cOR(95%CI) p-value aOR(95%CI) p -value Age Group 1-25yrs 15(15.50) 0.32(0.17–0.59) 45 37(38.10) Ref Ref Gender Male 38(38.00) Ref Ref Female 62(62.00) 1.36(0.90–2.06) 0.148 1.60(0.47–5.47) 0.456 VDRL Reactive 0(0.00) - - - - Non-Reactive 11(100.00) - - - - HBsAg - - - - Positive 2(16.70) 2.76(0.55–13.82) 0.218 2.96(0.55–15.99) 0.208 Negative 10(83.30) Ref Ref HCV - - - - Positive 0(0.0) - - - - Negative 2(100.00) - - - - Gonorrhea - - - - - Positive 2(2.20) - - - - Negative 0(0.00) - - - - aOR: Adjusted Odd Ratio, cOR crude Odd Ratio, CI Confident interval; Binary logistic regression analysis performed to obtain odd ratio; p -value < 0.05 was considered statistically significant; Bolded p -values were statistically significant. Demographic Predictors of HIV Positivity and Coinfection As shown in Table 4 , age demonstrated a statistically significant association with HIV status (p = 0.002). Participants aged 25–45 years constituted the majority of HIV-positive cases and accounted for half of the HIV coinfections, indicating a higher burden within the sexually active age group. No coinfections were recorded among individuals aged 1–25 years. Although a greater proportion of HIV-positive participants were female compared to males, the association between gender and HIV status was not statistically significant (p = 0.072). These findings suggest that age, rather than gender, is a key socio-demographic factor influencing HIV infection patterns in the study population.(Table 4 ). Table 4 Association Between Socio-Demographic Characteristics and HIV Status (Negative, Positive, and Coinfection) Among Study Participants Variable HIV-Negative [n(%)] HIV-Positive only [n(%)] HIV-Coinfection [n(%)] p -value Total 1456(100.0) 95(100.0) 2(100.0) Age Group (yrs) 0.002 1–25 396(27.2) 15(15.8) 0(0.0) 25–45 752(51.6) 44(46.3) 1(50.0) > 45 308(21.2) 36(37.9) 1(50.0) Gender 0.072 Male 670(45.5) 36(36.7) 2(100.0) Female 804(54.5) 62(63.3) 0(0.0) p -values computed by Chi-squared/Fisher’ s exact test. p -value < 0.05 was considered statistically significant Multinomial Logistic Regression of HIV Status (Negative, Positive, and Coinfection) Multinomial logistic regression (Table 5 ) revealed that participants aged 1–25 years had significantly lower odds of being HIV-positive (cOR = 0.32; 95% CI: 0.17–0.60; p = 0.001; aOR = 0.30; 95% CI: 0.16–0.57; p 45 years. Similarly, individuals aged 26–45 years were also less likely to be HIV-positive (cOR = 0.50; 95% CI: 0.32–0.79; p = 0.003). For HIV coinfection, age did not show a statistically significant relationship (p > 0.05), although the point estimates suggested higher odds among older participants. Gender differences were not significant in any of the models (p > 0.05), indicating that sex was not an independent predictor of HIV status in this study population (Table 5 ). Table 5 Multinomial Logistic Regression Analysis Showing Crude and Adjusted Odds Ratios (cOR and aOR) for Factors Associated with HIV Status Variable HIV-Positive cOR (95% CI) p -value HIV-Positive aOR (95% CI) p -value HIV-Co-infection cOR (95% CI) p- value HIV-Co-infection aOR (95% CI) p- value Age Group (yrs) 1–25 0.32 (0.17–0.60) 0.001 0.30 (0.16–0.57) 45 Ref Ref Ref - Ref Gender Male 0.70 (0.46–1.06) 0.094 0.71 (0.46–1.10) 0.128 1.43×10⁸ (—) 2.79×10⁸ (—) - Female Ref - Ref Ref Ref aOR: Adjusted Odd Ratio, cOR crude Odd Ratio, CI Confident interval; Multinomial logistic regression analysis performed to obtain odd ratio; p -value < 0.05 was considered statistically significant; Bolded p -values were statistically significant. Discussion Massive progress has been made globally and nationally in HIV awareness campaigns, prevention strategies, and access to testing and treatment; yet, HIV and other sexually transmitted infections (STIs) remain a significant public health burden in Ghana. This study investigated the prevalence and associated factors of HIV and other sexually transmitted infections (STIs) among outpatients in Ghana. The overall HIV prevalence of 6.4% observed in this cohort is markedly higher than the national adult prevalence of 2.0% (2.5% among women and 1.1% among men) reported by the Ghana AIDS Commission ( 18 , 19 ). The finding suggests a localized concentration of HIV transmission, potentially influenced by demographic, behavioral, or healthcare access factors. Comparatively, lower prevalence rates have been reported in Nigeria (1.6%) ( 20 ) and in national surveys across West Africa (1.4–2.8%), reflecting regional variation in HIV burden, awareness, and testing practices. Age was a significant determinant of HIV infection, with participants aged over 45 years exhibiting the highest prevalence, whereas younger groups (1–25 years and 25–45 years) showed significantly lower odds of infection. This pattern agrees another study that reported increasing age—particularly between 35 and 49 years - was positively associated with HIV infection in Ghana ( 21 ). Similar age-related trends have been reported elsewhere in sub-Saharan Africa ( 22 ). Older adults may have cumulative exposure to risk behaviors, reduced condom use, and age-related biological susceptibility ( 23 ). Although females accounted for a higher proportion of HIV cases (62%), the difference was not statistically significant after adjustment. The predominance among women corroborates Ghanaian data showing a female prevalence of 2.5% compared to 1.1% among men ( 18 ). This gender disparity has been consistently observed across Africa and may be explained by biological vulnerability, unequal power relations in sexual partnerships, and lower socioeconomic autonomy among women ( 9 ). The prevalence of hepatitis B virus (HBV) infection (13.0%) found in this study aligns with endemic HBV transmission patterns in Ghana. Agyeman and Ofori-Asenso (2016) reported a pooled HBV–HIV coinfection prevalence of 13.6% among HIV-positive patients, highlighting overlapping transmission routes ( 24 ). Syphilis prevalence (6.0%) in this study exceeded the 3.2% found in Asikuma Odoben Brakwa District( 25 ) but was within the range of 4.5–8.5% reported across major Ghanaian cities. Gonorrhea prevalence (15.6%) was higher than figures from several West African studies, indicating that bacterial STIs remain important facilitators of HIV transmission. The Hepatitis C virus (HCV) prevalence of 5.5% also surpassed Ghana’s estimated national rate of 3.0% ( 26 ), suggesting underdiagnosis or increased risk exposure among this population. Internationally, studies report diverse STI prevalence among HIV-positive individuals. In Iran, Hashemi-Shahri et al. (2016) documented coinfection rates of 12.1% for syphilis, 17% for gonorrhea, and 31% for HCV ( 27 ). In India, Saravanan et al. (2019) found that 23.65% of HIV patients had STI coinfections, predominantly among females ( 28 ). Such disparities may reflect variations in surveillance methods, healthcare access, and cultural norms influencing sexual behavior. Coi nfection of HIV with another STI was observed in 2.0% of HIV-positive participants, which is lower than international averages but clinically significant. STIs such as syphilis, herpes simplex virus type 2 (HSV-2), HBV, and HCV are known to enhance HIV transmission and progression through mucosal inflammation and immune activation ( 29 ). Furthermore, coinfections may accelerate liver disease progression and increase viral load, complicating ART management ( 29 ). These findings emphasize the importance of integrated STI/HIV testing and management protocols within outpatient and community health settings. Although behavioral variables were not assessed in this dataset, extensive literature links HIV infection to unprotected sex, multiple sexual partnerships, and intravenous drug use ( 30 ).Substance abuse, including alcohol consumption, impairs judgment and increases risky sexual practices ( 31 ). Men who have sex with men (MSM) also exhibit disproportionately high HIV prevalence, reflecting both biological susceptibility and social marginalization ( 30 ). Socioeconomic inequalities further compound vulnerability. Studies show that individuals with limited education or low income have poorer health-seeking behavior and lower access to preventive services ( 32 , 33 ). In Ghana, cost of treatment, stigma, and time constraints are major deterrents to regular testing and ART adherence ( 34 ). Health-seeking behavior plays a vital role in managing HIV infection and related comorbidities. Cheabu et al. (2023) demonstrated that people living with HIV (PLHIV) who engage with community cadres or alternative healthcare providers report better quality of life and adherence outcomes. However, stigma and mental health challenges continue to hinder access to care ( 35 ). Similar trends were reported in Pakistan, where 81.3% of HIV patients lacked formal education, affecting their health service utilization ( 36 ). Addressing psychosocial barriers through education, counseling, and community empowerment is therefore crucial to improving ART adherence and health outcomes. HIV prevalence varies globally. In Nigeria, Salako et al. (2022) recorded a 1.6% prevalence among clients attending testing services, whereas India and Iran report higher rates of HIV–STI coinfection ( 37 , 38 ). These international comparisons reinforce the regional heterogeneity of HIV epidemiology. The observed 6.4% prevalence in this Ghanaian outpatient cohort thus represents a moderate-to-high burden relative to both national and regional averages, signaling the need for targeted local interventions. The concurrent high prevalence of HIV and other sexually transmitted infections (STIs) observed in this study underscores persistent gaps in prevention, early detection, and treatment within the healthcare system. Strengthening surveillance systems, promoting routine co-screening, and intensifying community-level awareness campaigns are essential to reduce transmission and improve early diagnosis. Policy interventions should prioritize the expansion of integrated STI and HIV testing services across all outpatient departments, the development of age- and gender-sensitive health promotion programs, and the enhancement of psychosocial support systems aimed at reducing stigma and improving adherence to care. Furthermore, ensuring the accessibility and affordability of antiretroviral therapy (ART) and STI treatments through subsidized care is crucial to achieving sustained epidemic control and better health outcomes for affected populations. Limitations This study acknowledges the following limitations. First, the retrospective design relied on secondary hospital records, which may contain missing, incomplete, or inaccurately documented information, potentially affecting data quality. The study also lacked behavioral, socioeconomic, and clinical variables such as sexual practices, history of multiple partners, ART status, and intravenous drug use, which are important predictors of STI/HIV transmission; therefore, associations could not be fully explored. Laboratory diagnosis was dependent on routine hospital testing protocols, and not all participants were screened for every infection, which may have underestimated true prevalence and co-infection rates. Additionally, the single-center study setting limits generalizability to the broader Ghanaian population, particularly rural communities with different epidemiological patterns or healthcare access barriers. Conclusion The findings indicate a higher-than-national HIV prevalence and significant circulation of HBV, HCV, syphilis, and gonorrhea within the study population. Age was the only significant predictor of HIV infection, with older adults exhibiting greater vulnerability. Though HIV–STI coinfection was rare, its clinical implications warrant continued surveillance. Strengthening integrated STI/HIV screening, improving health education, and addressing socioeconomic barriers remain vital to reducing the dual burden of HIV and other sexually transmitted infections in Ghana. Declarations Ethics Approval Statement: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Mother of God Hospital, Ghana. As this was a retrospective study involving anonymized patient records, the requirement for informed consent was waived by the ethics committee. Acknowledgements The authors are grateful to study participants, as well as research assistants who contributed in diverse ways to the successful implementation of the study. Funding This study did not receive funding from private, government or non-for-profit organization. Competing interests Authors declare that no conflicts of interest exist. Ethics approval and consent to participate Approval was obtained from the management of Mother of God Hospital before the commencement of the study. Also, the confidentiality and anonymity of the study participants were ensured by data collected and coded using IDs and none of the data were required to add personal information. The study was conducted following the guidelines of the Helsinki declaration. Clinical Trial Number: Not applicable Availability of data and material All data generated or analyzed during this study are included in this article and can be requested from the corresponding author. Consent for publication All authors have approved the manuscript and agree with its final publication. Authors' contributions FA conceptualized this study. ES supervised the study. 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Int J Public Health [Internet]. 2023 [cited 2025 Dec 20];68:1605669. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10154531/ Abdulai MA, Marable JK, Wadus A, Asante KP. A qualitative analysis of factors influencing health-seeking behavior of people living with HIV, hypertension and diabetes in an urban area of Ghana. J Multimorbidity Comorbidity. 2022;12. Alsaiari SAS, Alsaiari ASF, Shamlan AMT, Al Fataih JAN, Alsayari SMA, Alshihe SHM, et al. Health Disparities in General Medicine: A Systematic Review of Socioeconomic and Demographic Influences. J ecohumanism. 2024;3(7):4603–12. Cheabu BSN, Kuunibe N, Nkegbe PK, Yeboah P, Duah J, Addae JK et al. Health-Seeking Behavior and Quality of Life of People Living With HIV: Novel Evidence From Ghana. J Int Association Providers AIDS Care. 2023;22. Dhaor SS. Health Seeking and ART Adherence Behaviour Among Persons Living with HIV AIDS in India. Asian Man (The) -. Int J. 2022;16(1). Bhutto AQ, Nisar N. Health-seeking behaviour of people living with HIV/AIDS and their satisfaction with health services provided at a tertiary care hospital, Karachi, Pakistan. East Mediterr Health J. 2017;23(1):13–9. Saravanan N, Swamiappan M, Kannan R, Raja GA. Sexually transmitted infections among HIV positive patients: a five year retrospective study. Int J Res Dermatology. 2019;5(1). Hashemi-Shahri SM, Sharifi-Mood B, Kouhpayeh HR, Moazen J, Farrokhian M, Salehi M. Sexually transmitted infections among hospitalized patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) in Zahedan, Southeastern Iran. Int J High Risk Behav Addict. 2016;5(3). 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-8414449","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":564677333,"identity":"28fc949f-7102-44b5-8dde-f15f497cb843","order_by":0,"name":"Felix Ayornu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYPACG34GdsYGhg9AJhs7cVrSJBuYGRsYZ4C0MBOn5TBQCwMDMw+ITUgL/4zkY58L25gl+JmZ26Rtfm2T52NmYPzwMQe3FokbacmzZ7axSUg2MzYb5/bdNmxjZmCWnLkNjzU3coyZedt46gwOMzY+zu25zQjUwsbMi0eLPESLhIT9YcaGw5Y9t+0JajGAaDGQMGAG2sLw43YiQS2GZ54lM/OcS5CQOMzYbNjbcDu5jZmxGa9f5I4nH2bmKfsvwd/e/kzix5/btvPbmw9++IjP+wIJSBzGNjDZgEc9EPAfQOb9wa94FIyCUTAKRiYAACD/Sc2DJsn4AAAAAElFTkSuQmCC","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Felix","middleName":"","lastName":"Ayornu","suffix":""},{"id":564677334,"identity":"42e28697-a4c9-452c-ae15-376aaf536c15","order_by":1,"name":"Jacob Tetteh Agbezuke","email":"","orcid":"","institution":"University for Development 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1","display":"","copyAsset":false,"role":"figure","size":14167,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HIV among participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/27de84e964e59070d482cbad.png"},{"id":99191319,"identity":"26fabed0-0626-4792-a754-bcc9574ee0a3","added_by":"auto","created_at":"2025-12-30 00:54:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14477,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HBsAg among participants\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/2fdd78f073257f70e26842e7.png"},{"id":99191326,"identity":"8c91a07b-f8b9-4aa2-ae34-9c02087871fa","added_by":"auto","created_at":"2025-12-30 00:54:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":12525,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Syphilis among participants\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/a0f567e68d4a9d198a4ee583.png"},{"id":99191333,"identity":"5ec70b8d-70df-4a38-8d44-2416fb341b84","added_by":"auto","created_at":"2025-12-30 00:54:55","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":13334,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HCV among participants\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/c901bb42da42c0c15080ec1c.png"},{"id":99191324,"identity":"4e5d323e-3b35-42c6-99a2-8ac39bc1733a","added_by":"auto","created_at":"2025-12-30 00:54:55","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":14198,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Gonorrhea among participants\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/21b744ea35e86d681b06385f.png"},{"id":99191322,"identity":"1ac9f71f-5bed-4968-b4b1-81c711622a9d","added_by":"auto","created_at":"2025-12-30 00:54:55","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":12288,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HIV Coinfection among participants\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/8d45f2248b557631f26cbeff.png"},{"id":99325906,"identity":"897abbf1-69f4-4d5a-8d09-7874ff7c31ed","added_by":"auto","created_at":"2025-12-31 16:50:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1282359,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8414449/v1/a5b974ca-4c51-46e2-a740-4e6c39e2e3a9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSexually transmitted infections (STIs) remain major global public health concerns with severe medical, social, and economic implications. From ancient history to modern times, these infections have persisted across societies and geographical boundaries, disproportionately affecting vulnerable populations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although more than 30 bacterial, viral, and parasitic pathogens are transmitted through sexual contact, the global burden is dominated by eight major infections\u0026mdash;gonorrhea, syphilis, chlamydia, trichomoniasis, hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), herpes simplex virus (HSV), and HIV (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While bacterial STIs such as chlamydia, gonorrhea, and syphilis are generally curable, the rapid emergence of antimicrobial resistance threatens treatment success and future disease control efforts (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In response, the World Health Organization (WHO) set ambitious 2030 targets, including a 90% global reduction in Treponema pallidum and Neisseria gonorrhoeae incidence from 2018 baselines, highlighting the urgency of strengthened surveillance, integrated screening, and effective treatment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe transmission of HIV, syphilis, HBV, HCV, and gonorrhea is closely intertwined due to shared sexual, parenteral, and perinatal modes of spread. Sexual exposure remains the leading route, and co-existing genital ulcers or inflammation significantly increase susceptibility to HIV acquisition (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Parenteral transmission, particularly among people who inject drugs, also contributes to high HIV/HBV/HCV co-infection rates worldwide (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), while untreated maternal infections contribute substantially to perinatal transmission and neonatal morbidity (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).These overlapping pathways amplify clinical complications; for example, syphilis accelerates HIV disease progression, while HIV\u0026ndash;HBV or HIV\u0026ndash;HCV co-infections lead to rapid liver fibrosis, cirrhosis, and higher non-AIDS mortality (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Evidence from China and other high-burden regions shows elevated co-infection in HIV-positive populations, largely driven by overlapping risk behaviors and gaps in prevention and routine screening (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSub-Saharan Africa bears the highest global burden of STIs and viral hepatitis, worsened by limited diagnostic capacity, cost barriers, and delayed treatment. Chlamydia prevalence rose by 34.5% between 2010 and 2020, reaching 6.6% among females and 4.7% among males (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), while HIV-related immunosuppression fuels high rates of opportunistic viral and fungal infections (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). HCV prevalence averages 5.3% across Africa but exceeds 6% in Central Africa, with higher morbidity among HIV-positive individuals (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A significant proportion of infections remain undiagnosed due to asymptomatic presentation, stigma, weak surveillance, and limited access to routine laboratory screening creating a persistent \u0026ldquo;silent burden.\u0026rdquo;\u003c/p\u003e \u003cp\u003eGhana reflects similar epidemiological patterns. Hepatitis B remains hyperendemic, with prevalence between 12.3% and 14.4% in the general population (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and HCV prevalence averages 6.04%, ranging from 1.3% in the Central Region to 20.9% in the Northern Region (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). HIV/HBV co-infection is also substantial at 13.6% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Southern Ghana, a recent study reported 24.7% STIs among symptomatic patients, dominated by gonorrhea, chlamydia, and syphilis, with 3.4% presenting multiple pathogens (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Yet co-screening remains uncommon, and many facilities rely on syndromic management due to cost and limited diagnostic capacity, despite rising antimicrobial resistance.\u003c/p\u003e \u003cp\u003eAlthough individual infections have been studied in Ghana, limited evidence describes their sero-epidemiological overlap in outpatient populations. Co-occurrence influences transmission dynamics, increases complications, and affects treatment decisions, but routine integrated screening is lacking. This study therefore maps the prevalence and co-occurrence of HIV, syphilis, HBV, HCV, and gonorrhea among outpatients in Ghana. Findings will provide baseline evidence to strengthen integrated STI surveillance, improve screening strategies, and inform policy interventions for prevention, early diagnosis, and effective clinical management.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and study site\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional design was used to study Sero-Epidemiological Prevalence and Co-occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea at the Mother of God Hospital (MOG) in the Greater Accra Region of Ghana. MOG is a primary hospital located in Ashaiman Lebanon- Ashaiman Municipal District, well-resourced and serving a population of about 8,000 annually.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study involved all individuals who visited the hospital on normal Out patients Department (OPD) basis as well as those who had been admitted.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003e Participants eligible for inclusion in this study where those who willingly gave informed consent, and for children, their parents gave accent for their participation in the study.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eIndividuals who decline informed consent and those who did not express their willingness to participate in the study was not considered.\u003c/p\u003e\n\u003ch3\u003eSample size calculation and sampling technique\u003c/h3\u003e\n\u003cp\u003eThe sample size for the study was determined using the Cochran\u0026rsquo;s formula: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{z}^{2}pq}{{e}^{2}}\\)\u003c/span\u003e\u003c/span\u003e ; where: n is the minimum sample size, p is the prevalence of HIV in Ghana\u0026thinsp;=\u0026thinsp;1.7% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), q\u0026thinsp;=\u0026thinsp;1-p, (98.3), z\u0026thinsp;=\u0026thinsp;z value at 95% confidence (1.96), and e is the margin of error (0.05). This gave minimum of twenty-six (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) participants required for the study. To increase representativeness and statistical power, one thousand, five hundred and seventy-eight (1,578) were included in the study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e Approval was obtained from the management of Mother of God Hospital before the commencement of the study. Also, the confidentiality and anonymity of the study participants were ensured by data collected and coded using IDs and none of the data were required to add personal information. The study was conducted following the guidelines of the Helsinki declaration.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData for this study was retrospectively extracted from the Hospital Information Management System (HMIS). The dataset contained anonymized records of outpatients and inpatient who visited the hospital between January and December 2024. Extracted variables included sociographic information (age and gender) as well as clinical data (test results for HIV, Hepatitis B surface antigen, Hepatitis C antibody, Syphilis and Gonorrhea).To ensure accuracy, the extracted data were cross-checked against laboratory registers and cleaned to removed duplicates, incomplete record and inconsistencies.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eData collected were entered into Microsoft Office Excel 2021, cleaned, coded and exported into the Statistical Package for Social Sciences version 26.0 (SPSS, Inc.; Chicago, IL, USA) and analyzed. GraphPad Prism 8.0 was used to plot all graphs. Categorical variables were presented as frequencies and percentages after performing descriptive statistics. Bar charts were used to illustrate the prevalence of HIV, HBsAg, HCV, Syphilis and Gonorrhea. Pearson chi-square test and Logistic regression were used to determine the association and predictors of HIV coinfection. \u003cem\u003ep\u003c/em\u003e - value of less that 0.005 and 95% confidence interval were considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of study participants\u003c/h2\u003e \u003cp\u003eA total of 1,578 participants were included in this study, comprising 708 males (44.9%) and 866 female (54.9%). The majority of participants were withing the 25\u0026ndash;45-year age group (50.5%), followed by those aged 1\u0026ndash;25 years (26.0%) and then \u0026gt;\u0026thinsp;45 years (21.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eSociodemographic Characteristics of participants\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\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\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\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (yrs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.9\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=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData presented as frequency and percentage\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003ePrevalence of HIV and Other Sexually Transmitted Infections\u003c/h2\u003e \u003cp\u003eThe overall prevalence of HIV among the study population was 6.4%. Hepatitis B surface antigen (HBsAg) positivity was observed in 13.0% of those tested. Syphilis recorded a prevalence of 6.0%.Gonorrea showed a prevalence of 15.6% while the least prevalence was recorded in Hepatitis C virus; 5.5%. Coinfections with HIV and another STI was rare, accounting for only 2.0% of all HIV-positive participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssociation Between HIV status and Sociodemographic Factors\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the bivariate associations between HIV infection and participants\u0026rsquo; characteristics. A significant association was observed between age and HIV positivity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the highest proportion of HIV-positive cases (38.1%) occurring among participants aged\u0026thinsp;\u0026gt;\u0026thinsp;45 years, compared to 15.5% in the 1\u0026ndash;25-year age group. Gender was not significantly associated with HIV infection (p\u0026thinsp;=\u0026thinsp;0.177), although females (62%) had higher HIV prevalence than males (38%). No significant associations were observed between HIV and other STIs (HBsAg, HCV, syphilis, or gonorrhea), all with p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.05 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eAssociation between HIV and participants sociodemographic as well as other STIs\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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\u003eHIV-Negative [n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHIV-Positive[n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1477(93.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101(6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-25years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e396(27.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(15.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e752(51.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(46.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e308(21.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(38.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e670(45.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(38.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e804(54.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(62.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVDRL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(5.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e270(94.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11(100.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHBsAg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(6.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(16.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e193(93.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(83.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(96.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGonorrhea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20(18.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90(81.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e-values computed by Chi-squared/Fisher\u0026rsquo; s exact test. \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLogistic Regression Analysis of Factors Associated with HIV Positivity\u003c/h2\u003e \u003cp\u003eBinary logistic regression identified age as a significant predictor of HIV infection. Participants aged 1\u0026ndash;25 years had lower odds of being HIV-positive compared to those aged\u0026thinsp;\u0026gt;\u0026thinsp;45 years (cOR\u0026thinsp;=\u0026thinsp;0.32; 95% CI: 0.17\u0026ndash;0.59; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Those aged 25\u0026ndash;45 years also had reduced odds (cOR\u0026thinsp;=\u0026thinsp;0.50; 95% CI: 0.32\u0026ndash;0.79; p\u0026thinsp;=\u0026thinsp;0.003). After adjustment for confounders, the associations were not statistically significant (aOR\u0026thinsp;=\u0026thinsp;0.88; 95% CI: 0.16\u0026ndash;4.92; p\u0026thinsp;=\u0026thinsp;0.881 for 1\u0026ndash;25 years; aOR\u0026thinsp;=\u0026thinsp;0.45; 95% CI: 0.10\u0026ndash;2.02; p\u0026thinsp;=\u0026thinsp;0.296). Gender showed no significant association with HIV positivity after adjustment (aOR\u0026thinsp;=\u0026thinsp;1.60; 95% CI: 0.47\u0026ndash;5.47; p\u0026thinsp;=\u0026thinsp;0.456). HBsAg-positive participants were more likely to be HIV-positive (aOR\u0026thinsp;=\u0026thinsp;2.96; 95% CI: 0.55\u0026ndash;15.99; p\u0026thinsp;=\u0026thinsp;0.208), though not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eLogistic Regression Analysis of Factors Associated with HIV Positivity Among Study Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\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\u003ePositive [n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-25yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(15.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32(0.17\u0026ndash;0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88(0.16\u0026ndash;4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(46.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50(0.32\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45(0.10\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(38.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(38.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(62.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.36(0.90\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.60(0.47\u0026ndash;5.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVDRL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHBsAg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(16.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.76(0.55\u0026ndash;13.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.96(0.55\u0026ndash;15.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(83.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGonorrhea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\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\u003eaOR: Adjusted Odd Ratio, cOR crude Odd Ratio, CI Confident interval; Binary logistic regression analysis performed to obtain odd ratio; \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant; Bolded \u003cem\u003ep\u003c/em\u003e-values were statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Predictors of HIV Positivity and Coinfection\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, age demonstrated a statistically significant association with HIV status (p\u0026thinsp;=\u0026thinsp;0.002). Participants aged 25\u0026ndash;45 years constituted the majority of HIV-positive cases and accounted for half of the HIV coinfections, indicating a higher burden within the sexually active age group. No coinfections were recorded among individuals aged 1\u0026ndash;25 years. Although a greater proportion of HIV-positive participants were female compared to males, the association between gender and HIV status was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.072). These findings suggest that age, rather than gender, is a key socio-demographic factor influencing HIV infection patterns in the study population.(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between Socio-Demographic Characteristics and HIV Status (Negative, Positive, and Coinfection) Among Study Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eHIV-Negative [n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHIV-Positive only [n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIV-Coinfection\u003c/p\u003e \u003cp\u003e[n(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1456(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group (yrs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e396(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e752(51.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44(46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e308(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e670(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e804(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62(63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e-values computed by Chi-squared/Fisher\u0026rsquo; s exact test. \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMultinomial Logistic Regression of HIV Status (Negative, Positive, and Coinfection)\u003c/h2\u003e \u003cp\u003eMultinomial logistic regression (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) revealed that participants aged 1\u0026ndash;25 years had significantly lower odds of being HIV-positive (cOR\u0026thinsp;=\u0026thinsp;0.32; 95% CI: 0.17\u0026ndash;0.60; p\u0026thinsp;=\u0026thinsp;0.001; aOR\u0026thinsp;=\u0026thinsp;0.30; 95% CI: 0.16\u0026ndash;0.57; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to those aged\u0026thinsp;\u0026gt;\u0026thinsp;45 years. Similarly, individuals aged 26\u0026ndash;45 years were also less likely to be HIV-positive (cOR\u0026thinsp;=\u0026thinsp;0.50; 95% CI: 0.32\u0026ndash;0.79; p\u0026thinsp;=\u0026thinsp;0.003). For HIV coinfection, age did not show a statistically significant relationship (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), although the point estimates suggested higher odds among older participants. Gender differences were not significant in any of the models (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that sex was not an independent predictor of HIV status in this study population (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultinomial Logistic Regression Analysis Showing Crude and Adjusted Odds Ratios (cOR and aOR) for Factors Associated with HIV Status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\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\u003eHIV-Positive cOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIV-Positive aOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHIV-Co-infection cOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHIV-Co-infection aOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\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 (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32 (0.17\u0026ndash;0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30 (0.16\u0026ndash;0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.23 \u0026times; 10⁻⁹ (\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.04\u0026times;10⁻⁹ (\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50 (0.32\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50 (0.32\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.41 (0.03\u0026ndash;6.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.40 (0.03\u0026ndash;6.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70 (0.46\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71 (0.46\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43\u0026times;10⁸ (\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.79\u0026times;10⁸ (\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eaOR: Adjusted Odd Ratio, cOR crude Odd Ratio, CI Confident interval; Multinomial logistic regression analysis performed to obtain odd ratio; \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant; Bolded \u003cem\u003ep\u003c/em\u003e-values were statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eMassive progress has been made globally and nationally in HIV awareness campaigns, prevention strategies, and access to testing and treatment; yet, HIV and other sexually transmitted infections (STIs) remain a significant public health burden in Ghana. This study investigated the prevalence and associated factors of HIV and other sexually transmitted infections (STIs) among outpatients in Ghana. The overall HIV prevalence of 6.4% observed in this cohort is markedly higher than the national adult prevalence of 2.0% (2.5% among women and 1.1% among men) reported by the Ghana AIDS Commission (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The finding suggests a localized concentration of HIV transmission, potentially influenced by demographic, behavioral, or healthcare access factors. Comparatively, lower prevalence rates have been reported in Nigeria (1.6%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and in national surveys across West Africa (1.4\u0026ndash;2.8%), reflecting regional variation in HIV burden, awareness, and testing practices.\u003c/p\u003e \u003cp\u003eAge was a significant determinant of HIV infection, with participants aged over 45 years exhibiting the highest prevalence, whereas younger groups (1\u0026ndash;25 years and 25\u0026ndash;45 years) showed significantly lower odds of infection. This pattern agrees another study that reported increasing age\u0026mdash;particularly between 35 and 49 years - was positively associated with HIV infection in Ghana (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Similar age-related trends have been reported elsewhere in sub-Saharan Africa (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Older adults may have cumulative exposure to risk behaviors, reduced condom use, and age-related biological susceptibility (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Although females accounted for a higher proportion of HIV cases (62%), the difference was not statistically significant after adjustment. The predominance among women corroborates Ghanaian data showing a female prevalence of 2.5% compared to 1.1% among men (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This gender disparity has been consistently observed across Africa and may be explained by biological vulnerability, unequal power relations in sexual partnerships, and lower socioeconomic autonomy among women (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of hepatitis B virus (HBV) infection (13.0%) found in this study aligns with endemic HBV transmission patterns in Ghana. Agyeman and Ofori-Asenso (2016) reported a pooled HBV\u0026ndash;HIV coinfection prevalence of 13.6% among HIV-positive patients, highlighting overlapping transmission routes (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Syphilis prevalence (6.0%) in this study exceeded the 3.2% found in Asikuma Odoben Brakwa District(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) but was within the range of 4.5\u0026ndash;8.5% reported across major Ghanaian cities. Gonorrhea prevalence (15.6%) was higher than figures from several West African studies, indicating that bacterial STIs remain important facilitators of HIV transmission. The Hepatitis C virus (HCV) prevalence of 5.5% also surpassed Ghana\u0026rsquo;s estimated national rate of 3.0% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), suggesting underdiagnosis or increased risk exposure among this population.\u003c/p\u003e \u003cp\u003eInternationally, studies report diverse STI prevalence among HIV-positive individuals. In Iran, Hashemi-Shahri et al. (2016) documented coinfection rates of 12.1% for syphilis, 17% for gonorrhea, and 31% for HCV (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In India, Saravanan et al. (2019) found that 23.65% of HIV patients had STI coinfections, predominantly among females (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Such disparities may reflect variations in surveillance methods, healthcare access, and cultural norms influencing sexual behavior.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCoi\u003c/strong\u003e \u003cp\u003enfection of HIV with another STI was observed in 2.0% of HIV-positive participants, which is lower than international averages but clinically significant. STIs such as syphilis, herpes simplex virus type 2 (HSV-2), HBV, and HCV are known to enhance HIV transmission and progression through mucosal inflammation and immune activation (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Furthermore, coinfections may accelerate liver disease progression and increase viral load, complicating ART management (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). These findings emphasize the importance of integrated STI/HIV testing and management protocols within outpatient and community health settings.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAlthough behavioral variables were not assessed in this dataset, extensive literature links HIV infection to unprotected sex, multiple sexual partnerships, and intravenous drug use (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).Substance abuse, including alcohol consumption, impairs judgment and increases risky sexual practices (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Men who have sex with men (MSM) also exhibit disproportionately high HIV prevalence, reflecting both biological susceptibility and social marginalization (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Socioeconomic inequalities further compound vulnerability. Studies show that individuals with limited education or low income have poorer health-seeking behavior and lower access to preventive services (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In Ghana, cost of treatment, stigma, and time constraints are major deterrents to regular testing and ART adherence (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealth-seeking behavior plays a vital role in managing HIV infection and related comorbidities. Cheabu et al. (2023) demonstrated that people living with HIV (PLHIV) who engage with community cadres or alternative healthcare providers report better quality of life and adherence outcomes. However, stigma and mental health challenges continue to hinder access to care (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Similar trends were reported in Pakistan, where 81.3% of HIV patients lacked formal education, affecting their health service utilization (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Addressing psychosocial barriers through education, counseling, and community empowerment is therefore crucial to improving ART adherence and health outcomes.\u003c/p\u003e \u003cp\u003eHIV prevalence varies globally. In Nigeria, Salako et al. (2022) recorded a 1.6% prevalence among clients attending testing services, whereas India and Iran report higher rates of HIV\u0026ndash;STI coinfection (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). These international comparisons reinforce the regional heterogeneity of HIV epidemiology. The observed 6.4% prevalence in this Ghanaian outpatient cohort thus represents a moderate-to-high burden relative to both national and regional averages, signaling the need for targeted local interventions.\u003c/p\u003e \u003cp\u003eThe concurrent high prevalence of HIV and other sexually transmitted infections (STIs) observed in this study underscores persistent gaps in prevention, early detection, and treatment within the healthcare system. Strengthening surveillance systems, promoting routine co-screening, and intensifying community-level awareness campaigns are essential to reduce transmission and improve early diagnosis. Policy interventions should prioritize the expansion of integrated STI and HIV testing services across all outpatient departments, the development of age- and gender-sensitive health promotion programs, and the enhancement of psychosocial support systems aimed at reducing stigma and improving adherence to care. Furthermore, ensuring the accessibility and affordability of antiretroviral therapy (ART) and STI treatments through subsidized care is crucial to achieving sustained epidemic control and better health outcomes for affected populations.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study acknowledges the following limitations. First, the retrospective design relied on secondary hospital records, which may contain missing, incomplete, or inaccurately documented information, potentially affecting data quality. The study also lacked behavioral, socioeconomic, and clinical variables such as sexual practices, history of multiple partners, ART status, and intravenous drug use, which are important predictors of STI/HIV transmission; therefore, associations could not be fully explored. Laboratory diagnosis was dependent on routine hospital testing protocols, and not all participants were screened for every infection, which may have underestimated true prevalence and co-infection rates. Additionally, the single-center study setting limits generalizability to the broader Ghanaian population, particularly rural communities with different epidemiological patterns or healthcare access barriers.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings indicate a higher-than-national HIV prevalence and significant circulation of HBV, HCV, syphilis, and gonorrhea within the study population. Age was the only significant predictor of HIV infection, with older adults exhibiting greater vulnerability. Though HIV\u0026ndash;STI coinfection was rare, its clinical implications warrant continued surveillance. Strengthening integrated STI/HIV screening, improving health education, and addressing socioeconomic barriers remain vital to reducing the dual burden of HIV and other sexually transmitted infections in Ghana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval Statement: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Mother of God Hospital, Ghana. As this was a retrospective study involving anonymized patient records, the requirement for informed consent was waived by the ethics committee.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to study participants, as well as research assistants who contributed in diverse ways to the successful implementation of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding from private, government or non-for-profit organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that no conflicts of interest exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the management of Mother of God Hospital before the commencement of the study. Also, the confidentiality and anonymity of the study participants were ensured by data collected and coded using IDs and none of the data were required to add personal information. The study was conducted following the guidelines of the Helsinki declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article and can be requested from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have approved the manuscript and agree with its final publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFA conceptualized this study. ES supervised the study. FA and ES were involved in the statistical analyses; FA, JAT, GS and ES were involved in study design, data curation, methodology, and manuscript drafting. All authors reviewed the manuscript and approved it for final publications.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eElendu C, Amaechi DC, Elendu ID, Elendu TC, Amaechi EC, Usoro EU, et al. Global perspectives on the burden of sexually transmitted diseases: A narrative review. Med (United States). 2024;103(20):E38199.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health. 2023;38(6):675\u0026ndash;700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu M, Yan W, Jing W, Qin C, Liu Q, Liu M et al. 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J Multimorbidity Comorbidity. 2022;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlsaiari SAS, Alsaiari ASF, Shamlan AMT, Al Fataih JAN, Alsayari SMA, Alshihe SHM, et al. Health Disparities in General Medicine: A Systematic Review of Socioeconomic and Demographic Influences. J ecohumanism. 2024;3(7):4603\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheabu BSN, Kuunibe N, Nkegbe PK, Yeboah P, Duah J, Addae JK et al. Health-Seeking Behavior and Quality of Life of People Living With HIV: Novel Evidence From Ghana. J Int Association Providers AIDS Care. 2023;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhaor SS. Health Seeking and ART Adherence Behaviour Among Persons Living with HIV AIDS in India. Asian Man (The) -. Int J. 2022;16(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhutto AQ, Nisar N. Health-seeking behaviour of people living with HIV/AIDS and their satisfaction with health services provided at a tertiary care hospital, Karachi, Pakistan. East Mediterr Health J. 2017;23(1):13\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaravanan N, Swamiappan M, Kannan R, Raja GA. Sexually transmitted infections among HIV positive patients: a five year retrospective study. Int J Res Dermatology. 2019;5(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashemi-Shahri SM, Sharifi-Mood B, Kouhpayeh HR, Moazen J, Farrokhian M, Salehi M. Sexually transmitted infections among hospitalized patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) in Zahedan, Southeastern Iran. Int J High Risk Behav Addict. 2016;5(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"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":"HIV, sexually transmitted infections, co-infection, hepatitis B, hepatitis C, syphilis, gonorrhea, Ghana, outpatient cohort, cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8414449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8414449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Sexually transmitted infections (STIs) remain a major public health burden in low- and middle-income countries, particularly in sub-Saharan Africa where diagnostic limitations and asymptomatic infections contribute to under-reporting. However, in Ghana, data on the co-occurrence of HIV with other STIs in outpatient settings are limited. This study assessed the prevalence and co-infection patterns of HIV, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and gonorrhea among outpatients in the Greater Accra Region of Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cross-sectional study involving 1,578 outpatients was conducted at a primary healthcare facility between January and December 2024. Sociodemographic and laboratory data were extracted from the hospital information management system. Descriptive statistics summarized prevalence of HIV and other STIs. Chi-square tests and binary logistic regression were used to determine associations and predictors of HIV infection. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of the 1,578 participants, 54.9% were female, and most (50.5%) were aged 25–45 years. Overall HIV prevalence was 6.4%, while HBV, HCV, syphilis, and gonorrhea were 13.0%, 5.5%, 6.0%, and 15.6%, respectively. HIV–STI co-infection represented 2.0% of all HIV-positive cases. Age was significantly associated with HIV status (p = 0.002), with the highest positivity recorded among individuals \u0026gt;45 years. Logistic regression showed that participants aged 1–25 years (aOR = 0.30; 95% CI: 0.14–0.63; p \u0026lt; 0.001) and 26–45 years (aOR = 0.50; 95% CI: 0.31–0.83; p = 0.003) had significantly lower odds of HIV infection compared to those \u0026gt;45 years. Gender and the presence of other STIs were not significantly associated with HIV positivity (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e A considerable burden of HIV and other STIs was observed, with low but notable co-infection rates. Individuals older than 45 years were at highest risk of HIV infection. Strengthening integrated HIV/STI screening, promoting early diagnosis, and targeting age-specific health education particularly for older adults are critical to improving prevention and control strategies in Ghanaian outpatient settings.\u003c/p\u003e","manuscriptTitle":"Mapping the Silent Burden: Sero-Epidemiological Prevalence and Co- occurrence of HIV, Syphilis, Hepatitis B, Hepatitis C, and Gonorrhea in 1578 Ghanaian Outpatient Cohort using a Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:54:50","doi":"10.21203/rs.3.rs-8414449/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":"f4e122ed-0c68-416e-ab60-5bd1fc6cea92","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-31T16:36:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 00:54:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8414449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8414449","identity":"rs-8414449","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}