Hepatitis B coinfection and awareness among patients with active tuberculosis in Georgia: a cross-sectional study

Background Patients with TB disease in Georgia are not routinely tested for HBV and the prevalence of chronic HBV among TB patients is unknown. We aimed to assess the prevalence of HBV coinfection and immunity among persons with TB in Georgia and evaluate their HBV-related knowledge and attitudes toward vaccination. Methods We conducted a cross-sectional study among persons with active TB disease at the National Center for Tuberculosis and Lung Diseases in Georgia from September 20, 2024 to February 20, 2025. Participants underwent serologic testing (HBsAg, anti-HBs, anti-HBc) and completed a questionnaire on HBV knowledge, vaccination history, and willingness to vaccinate. Results We enrolled 110 participants (median age = 44.0, IQR:35.0-56.3), of which 63.6% were male. Four participants (3.6%) were HBsAg positive. HBV test results showed 14 (12.7%) had past HBV infection with anti-HBc+/anti-HBs+, and 7 (6.4%) had isolated anti-HBc positivity (anti-HBc+/anti-HBs-). Another seven (6.4%) had vaccine-induced immunity (anti-HBc-/anti-HBs+), and 82 (74.5%) were susceptible to HBV infection. While 74.5% reported having heard of HBV, only 50.0% correctly identified transmission routes. Only 16 patients (14.5%) were willing to receive vaccination. Among those unwilling, the main barriers were concerns about vaccine safety (34.9%), effectiveness (23.3%), and perceived infection risk (20.9%). Participants aged ≤ 40 years were significantly more likely to be aware of HBV compared to those over 40 (OR=3.39, 95% CI: 1.25–9.20). Conclusion TB-HBV coinfection observed in this study suggests that routine HBV screening among TB patients in Georgia may be beneficial. Low vaccination coverage and limited knowledge highlight the importance of integrating HBV education and vaccination into TB programs to improve outcomes.