Prevalence and correlates of serological markers of HBV infectivity and recent infection among HBsAG-positive inmates in Ghanaian correctional facilities

Correctional facilities are recognized as high-risk settings for the transmission of blood-borne infections, including hepatitis B virus (HBV), owing to overcrowding, high-risk behaviours, and limited access to healthcare. Higher prevalence of HBV among incarcerated populations in Ghana compared with the general population highlights the need to evaluate serological markers associated with infectivity and recent infection. This study assessed the prevalence of hepatitis B e antigen (HBeAg) and immunoglobulin M antibodies to hepatitis B core antigen (anti-HBc IgM) among hepatitis B surface antigen (HBsAg)-positive inmates in correctional facilities in Ghana. A cross-sectional secondary analysis was conducted using 323 archived plasma samples from HBsAg-positive inmates collected during a nationwide prison survey. HBeAg and anti-HBc IgM were determined using enzyme-linked immunosorbent assays (ELISAs). Associations between these serological markers and demographic, behavioural, clinical, and incarceration-related characteristics were evaluated. Of the 323 HBsAg-positive samples analysed, 91 (28.2%) were HBeAg positive and 16 (5.0%) were anti-HBc IgM positive. HBeAg positivity was significantly associated with prison type ( p < 0.001) and duration of incarceration ( p < 0.05). Most inmates who tested positive for anti-HBc IgM had been incarcerated for more than one year. However, no significant associations were observed between anti-HBc IgM positivity and the demographic variables examined. A substantial proportion of HBsAg-positive inmates had serological markers associated with increased HBV infectivity, while a small proportion had anti-HBc IgM, a marker that may indicate recent infection but can also occur during flares of chronic HBV infection. Although these findings highlight the potential for HBV transmission within correctional facilities, the cross-sectional design and absence of pre-incarceration serological data preclude confirmation of intra-prison transmission. Strengthened HBV screening, vaccination, clinical management, and longitudinal studies incorporating HBV DNA testing are warranted to better characterize HBV transmission in correctional settings. Not applicable.