Hepatitis B virus testing, vaccination, and hepatitis B surface antigen prevalence among adult inpatients at an urban polyclinic in Accra, Ghana: a cross-sectional study

Background Hepatitis B virus (HBV) infection is endemic in Ghana, mostly due to vertical transmission and limited vaccine coverage. We estimated hepatitis B surface antigen (HBsAg) prevalence and assessed HBV infection, testing, vaccination, and associated risk factors among adult inpatients receiving care at an urban polyclinic. Methods A hospital-based cross-sectional study was conducted among 313 adult inpatients at Kaneshie Polyclinic (Accra) from September 2020 to September 2021. We administered structured questionnaires, collected venous blood via standard venipuncture, and detected HBsAg using ACON One Step rapid immunochromatographic test, with 99.9% sensitivity and 99.7% specificity. All reactive tests were repeated for confirmation. Pearson's χ 2 tests and binary logistic regression were used to assess factors associated with HBsAg positivity, prior testing, and HBV vaccination. Results Participants' average age was 43.2 (±12.2 SD) years, and the majority were married (71.9%) and male (54.6%). HBsAg prevalence was 14.4% (95% confidence interval [CI]: 10.7–18.8). Prior HBV testing occurred in 32.6%, and full vaccination (≥3 doses) in 11.8%. None of the fully vaccinated participants were HBsAg-positive. Family history was positively associated with infection (adjusted odds ratio [AOR]: 2.54; 95% CI: 1.05–6.16), while low monthly income was associated with reduced odds of hepatitis B testing (AOR: 0.18, 95% CI: 0.05–0.62) and vaccination (AOR: 0.55, 95% CI: 0.17–1.82). Vaccination was protective in those who received it. Conclusion This study found a high prevalence of HBsAg positivity, low testing, and inadequate vaccine coverage among inpatients in an urban polyclinic. To reduce transmission risks, population-specific interventions that raise public knowledge of HBV transmission and prevention are required. Findings also support routine HBV screening and subsidized vaccination for adult inpatients, with targeted outreach to low-income groups and household contacts of known cases.