Risk Factors Associated with Hepatitis B Virus Seropositivity Among Adults in Nimba County, Liberia: A Cross-Sectional Study

Abstract Introduction: There continues to be a high prevalence of hepatitis B virus (HBV) infection as the leading cause of cirrhosis and liver cancer globally, particularly in sub-Saharan Africa. There is disproportionately high prevalence in Liberia, with the chronic infection rate of the country being several times the global average. Limited information exists on the community-based determinants of infection; no such data have been generated for the northeastern Nimba County. Objective The objective of the study was to determine the socio-demographic, behavioral, and Health Belief Model (HBM) attitude risk factors associated with hepatitis B surface antigen (HBsAg) seropositivity in a Liberian community sample and to determine the predictors of infection. Methods A cross-sectional sero-prevalent study involving 267 individuals attending two health facilities in Tappita district, Nimba County (October 2025-March 2026) was carried out, in which their serum samples were tested for hepatitis B surface antigen (HBsAg) while information was collected on socio-demographic and behavioral variables along with ten behavioral/clinical exposures and fifteen HBM attitudinal items by a structured questionnaire. Chi-square test was used to compare variables and predictors of infection with binary logistic regression, while intercorrelations among risk exposures were analyzed using Spearman’s correlation. Key results: The present study demonstrated that there was an overall HBsAg seroprevalence of 28.8% in the 267 individuals involved in the study, and no statistically significant associations existed between socio-demographic or HBM attitudinal variables and seropositivity (P > 0.05). However, seven behavioral and clinical exposures were significant in bivariate logistic analysis. Independent predictors of infection with multivariate logistic regression analysis included previous history of Hepatitis B virus (HBV) infection with an adjusted odds ratio (OR) of 10.69 (95% CI: 2.77–41.25), history of tattooing/piercing/scarification (OR: 2.32, 95% CI: 1.25–4.32), and presence of jaundice (OR: 1.93, approaching significance). The identified risk exposures were significantly inter-correlated. Conclusion In this hyper-endemic Liberian population, risk behaviors and/or clinical presentations significantly predicted seropositivity. Neither demographic characteristics nor health beliefs were found to influence seropositivity. Findings suggest that the risk-factor approach, rather than the health-belief approach, should be utilized in targeting HBV screening and prevention efforts.