Knowledge and attitudes towards hepatitis B and hepatitis C among people living with HIV in Blantyre, Malawi: a cross-sectional survey

Introduction The high burden of hepatitis B and C is compounded by the high prevalence of HIV in sub-Saharan Africa. HIV–viral hepatitis co-infection increases the risk of liver-related complications, yet knowledge, attitudes, and testing practices among people living with HIV (PLWHIV) remain poorly characterized. This study assessed knowledge, attitudes, and utilization of viral hepatitis testing services among PLWHIV in Blantyre, Malawi.Methods A cross-sectional survey was conducted among 299 PLWHIV attending urban and peri-urban antiretroviral therapy clinics between January and February 2025. Participants were recruited through non-probability consecutive sampling and completed structured questionnaires assessing sociodemographic characteristics, testing practices, knowledge, and attitudes towards viral hepatitis. Data were analyzed using SPSS version 27. Descriptive statistics summarized participant characteristics and study outcomes, while chi-square and Fisher’s exact tests assessed associations between categorical variables.Results Most participants were female (74.3%), aged 35–49 years (46.5%), and married (66.6%). Overall, 63.5% of participants had never been tested for viral hepatitis, 65.6% demonstrated poor knowledge, and 85.6% expressed positive attitudes towards prevention. Knowledge was higher among participants identifying as sexual minorities (gay or lesbian) than among heterosexual participants (p = 0.039), while positive attitudes were more frequent among employed participants (p = 0.005).Discussion The findings demonstrate substantial knowledge gaps and low testing uptake despite generally positive attitudes towards viral hepatitis prevention. Integrating targeted hepatitis education and routine testing into HIV care may improve access to prevention and testing services. Further research should evaluate the effectiveness of integrated education and testing interventions among PLWHIV.