A cross-sectional analysis of prevalence and risk factors for HIV, HBV and HCV among hemodialysis patients from Buea, Cameroon

Abstract

Background

Hemodialysis patients are at increased risk of acquiring blood-borne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections because of their susceptibility to invasive procedures and their immunosuppressive state. This study aimed to determine the prevalence of HIV, HBV, and HCV among hemodialysis patients at the Buea Regional Hospital (BRH) and identify potential risk factors for transmission.

Methods

A facility-based cross-sectional study was conducted between April and June 2024 among patients receiving maintenance hemodialysis at the BRH, Cameroon. A minimum sample size of 88 participants was calculated; 100 eligible patients were enrolled. Data were collected using a structured questionnaire to assess sociodemographic characteristics, risk factors, and knowledge of HIV, HBV, and HCV. Serological testing for HIV, HBV, and HCV was performed using rapid diagnostic test kits according to manufacturers’ instructions. Infection prevention practices were assessed through direct observation of hemodialysis sessions. Data were analyzed using SPSS Statistics version 22.0, with associations assessed at p < 0.05.

Results

The prevalence rates of HIV, HBV, and HCV were 17.0%, 9.0%, and 3.0%, respectively. HIV positivity was significantly associated with lower education and a history of sexually transmitted infections. Most participants demonstrated moderate to good knowledge of these infections; however, only 38% recognized HBV as vaccine-preventable, and just 5% reported receiving the vaccine. Observations revealed gaps in infection control, including inadequate hand hygiene and absence of dedicated areas for patients with known infections.

Conclusion

Hemodialysis patients at BRH carry a high burden of blood-borne infections. Strengthened vaccination programs, improved infection control, and larger multi-center studies are needed to reduce transmission risks among patients with chronic kidney disease in Cameroon.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-026-12587-1.

Background

According to the World Health Organization, chronic kidney disease (CKD) is characterized by the gradual loss of kidney function, with the kidneys filtering waste products from the blood for excretion in the urine [1]. Approximately 800 million individuals worldwide are affected by kidney failure, a progressive disease [2]. In Africa, particularly sub-Saharan Africa, the prevalence of kidney failure is increasing. A 2023 study indicated that the epidemiological data on kidney failure are of low to medium quality, underscoring the urgent need for reliable data to inform accurate health planning [3].

In Cameroon, the prevalence of CKD varies from 3 to 14.1 and 10.0%-14.2% in rural and urban areas, respectively [4]. Approximately one in ten adults suffers from kidney failure, which presents a significant economic burden on patients [4]. While kidney failure can be managed through hemodialysis, many patients are increasingly turning to this treatment and, when appropriate, renal replacement therapy (RRT). Unfortunately, the lack of access to dialysis or transplantation results in the deaths of more than half of all patients in need of RRT [5].

If proper hygienic precautions are not taken during regular dialysis sessions, patients may be exposed to infections from dialysis units, including bacterial, fungal, and viral infections [6]. Studies have shown that undergoing hemodialysis increases the likelihood of acquiring viral infections such as HBV, HCV, and HIV, primarily due to increased exposure from blood transfusions and hemodialysis interventions [7].

In resource‑limited hemodialysis settings across sub‑Saharan Africa, infection prevention and control remain major challenges. Studies have documented high rates of catheter‑related bloodstream infections and poor adherence to standard precautions, often linked to shortages of supplies, inadequate staff training, and weak infrastructure [8–10]. A recent systematic review highlighted the burden of hospital‑acquired infections in the region particularly blood-stream infections [11], underscoring the vulnerability of dialysis patients to blood‑borne pathogens. These challenges highlight the urgent need for reliable prevalence data and strengthened infection prevention measures in Cameroon.

Several risk factors contribute to the transmission of these infections to patients and healthcare workers, including failure to follow standard precautions, reusing disposable items, inadequate handwashing, reusing gloves, and not disinfecting surfaces [12].

Specifically, prior studies performed at hemodialysis centers in Cameroon, including the Buea Hemodialysis Center, reported high rates of HIV, HBV, and HCV, presumably due to low adherence to infection control measures, as the center opened only in 2011 [13, 14]. This research aims to investigate the current prevalence of HIV, HBV, and HCV among hemodialysis patients at the Buea Regional Hospital to understand the extent of these infections and their associated risk factors.

Methods

Study design and setting

This study was a descriptive cross-sectional analysis conducted at the Buea Regional Hospital, a tertiary center located in Buea, the capital of the southwestern region of Cameroon. Eligible participants were patients aged 21 years and older who underwent hemodialysis at the Buea Regional Hospital, and provided written informed consent.

The study was carried out at the Buea Regional Hospital (BRH), a tertiary healthcare facility located in Buea, the capital of the southwestern region of Cameroon. BRH serves as a major referral hospital for the region and offers a wide range of services, including internal medicine, surgery, pediatrics, obstetrics/gynecology, and specialized units such as the hemodialysis center and HIV treatment center. It also functions as a teaching hospital affiliated with the Faculty of Health Sciences, University of Buea.

Study sampling and data collection

The minimum sample size (N) for this study was calculated via the Lorentz formula, considering a prevalence of 6.13% from a similar study [7], a precision level (ɛ) of 5%, and a Z constant of 1.96. This calculation resulted in an estimated sample size of 88 participants to be enrolled.

A consecutive and exhaustive sampling technique was used to target all eligible participants performing hemodialysis at the Buea Regional Hospital during the study period (April – June 2024). Recruitment occurred during routine dialysis sessions across all operational days of the week. All patients present in the unit were approached in person, informed about the study, and invited to participate. No proactive contact via hospital records was made; enrollment was limited to patients physically attending dialysis sessions. To prevent duplicate enrollment, each participant was assigned a unique study identifier.

Of the total 120 patients receiving hemodialysis at BRH during the study period, 100 were enrolled, representing approximately 83% of the dialysis population. None of the patients had advanced malignancies. Six patients declined participation and therefore were not enrolled. Data were collected using a structured, interviewer administered questionnaire, supplemented by rapid diagnostic testing.

Study questionnaire

The questionnaire was specifically designed for this study to assess participants’ demographic characteristics, knowledge of HIV, HBV, and HCV, and select behavioral and clinical risk factors. It did not include attitude measures; practices were captured indirectly through questions on screening history, vaccination status, transfusion, and lifestyle exposures. The full questionnaire is provided as Supplementary File 1. Knowledge questions were scored on a scale of 1 to 5 depending on the accuracy of the response. Each participant’s total score was converted into a percentage of the maximum possible score, with > 75% classified as good knowledge, 50–75% as moderate knowledge, and < 50% as poor knowledge.

Laboratory testing

Blood samples (2–3 ml) were collected from the veins of patients who underwent hemodialysis at Buea Regional Hospital in a well-labeled and anticoagulant-free dry tube. On arrival at the laboratory, the samples were centrifuged at 3000 rpm for five minutes, and the serum was used for HIV, HBV and HCV screening via rapid immunochromatographic strip tests in accordance with the manufacturer’s instructions. The assays used were as follows: Determine HIV-1/2 (Abbott Diagnostics Medical Co., Ltd.) [15], Hightop HBsAg Test Strip (Qingdao Hightop Biotech Co., Ltd., Shandong, China) [16], and Hightop HCV Antibody Test strip (Qingdao Hightop Biotech Co., Ltd., Shandong, China [17]). According to the manufacturers’ package inserts, these assays have sensitivities of 100%, 100%, and 99.49%, respectively. The specificities of these assays were 99.75%, 99.84%, and 99.22%, respectively. These values were not generated in the present study but are reported here to provide context on assay performance.

Health care worker (provider) observation

In addition to patient questionnaires and laboratory testing, a structured observation of provider practices was conducted. A total of 100 hemodialysis sessions were observed from the thirty regular staff (nurses) working in the dialysis unit during the study period, covering multiple visits per patient. Observations were recorded at the level of dialysis sessions rather than per individual provider, as staff often participated in multiple visits. Observations were made on different days of the week to capture variability in practice. The purpose of the observation was disclosed to providers prior to data collection. Data collected included adherence to infection prevention and control measures, such as hand hygiene, glove use, and equipment handling.

Statistical analysis

Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize demographic characteristics, risk factors, and prevalence estimates, with results presented as frequencies, percentages, and means (± standard deviation) where appropriate. Associations between categorical variables and infection status (HIV, HBV, HCV) were assessed using the Chi-square test or Fisher’s exact test when expected cell counts were below five. A p-value below 0.05 was considered statistically significant. No correction for multiple comparisons was applied.

Results

Description of the study participants

A total of 100 participants were enrolled at the hemodialysis unit of the Buea Regional Hospital (BRH). The participants’ ages ranged from 21 to 75 years, with a mean age of 45.9 (± 13.0) years. The 41–50 age group accounted for the majority (33/100; 33.0%) of the population. The male-to-female sex ratio was 3:2, in favor of males. Most participants resided in Buea (50/100; 50.0%) or other localities within the southwestern region (48.0%). Educationally, participants had a primary (44/100; 44.0%) or secondary (27/100; 27.0%) level of education. Up to 40% of the participants were unemployed; among those employed, the majority were engaged in skilled labor (17/100; 17.0%) or the business sector (12/100; 12.0%). Table 1 provides a detailed overview of the sociodemographic distribution of the study population.

Table 1.

Description of participants’ sociodemographic data

Characteristics	Category	Frequency (n)	Percentage (%)
Age Group	21–30	14	14.0
	31–40	17	17.0
	41–50	33	33.0
	51–60	22	22.0
	61–70	10	10.0
	> 71	4.0	4.0
Sex	Male	60	60.0
	Female	40	40.0
Residence	Buea	50	50.0
	Other cities (South West region)	48	48.0
	Other regions	2	2.0
Education Level	Primary	44	44.0
	Secondary	27	27.0
	University	18	18.0
	High school	11	11.0
Occupation	Unemployed	40	40.0
	Skilled labor	17	17.0
	Business sector	12	12.0
	Transport sector	7	7.0
	Education	7	7.0
	Agriculture	6	6.0
	Others	11	11.0

Prevalence of HIV, HBV and HCV among hemodialysis patients and associations with participant characteristics

Among patients with chronic kidney disease receiving maintenance hemodialysis at the Buea Regional Hospital, the overall prevalence of at least one of the three viral infections was 29% (29/100). Within this hemodialysis population, the seroprevalence rates were 17.0% (17/100) for HIV, 9.0% (09/100) for HBV, and 3.0% (03/100) for HCV (Fig. 1). No cases of coinfections were observed.

Fig. 1.

Frequencies of HIV, HBV and HCV among hemodialysis patients

Prior to the initiation of hemodialysis, 10% (10/100) of patients reported having an HIV infection, while no history of HBV or HCV infection was recorded.

Associations between participant characteristics and HIV, HBV and HCV statuses

Table 2 presents the associations between various demographic and health-related characteristics of participants and their statuses for HIV, HBV, and HCV. Individuals aged 41–60 years had a significantly greater prevalence of HIV (14/55; 25.5%, P = 0.044), with an odds ratio (OR) of 4.9, indicating a greater likelihood of infection than the reference group did (ages 21–40). No significant associations were observed for HBV or HCV in this age group. However, a higher prevalence of HCV positivity was recorded in the age group above 60 years (2/14; 14.3%).

Table 2.

Association between participant characteristics and HIV, HBV and HCV status

Variable	Category	Tested	HIV			HBV			HCV
			HIV+ N (%)	P value	OR (CI)	HBV+ N (%)	P value	OR (CI)	HCV+ N (%)	P value	OR (CI)
Age group	21–40	31	2 (6.5)	Ref	Ref	4 (12.9)	Ref	Ref	0	Ref	Ref
	41–60	55	14 (25.5)	0.044**	4.9 [1.0; 23.4]	5 (9.1)	0.581	0.6 [0.1; 2.7]	1 (1.8)	0.998	2.9E7
	> 60	14	1 (7.1)	0.931	1.1 [0.1; 13.4]	0	0.999	0.0	2 (14.3)	0.998	2.6E7
Sex	Male	60	7 (11.7)	Ref	Ref	6 (10.0)	Ref	Ref	3 (5.0)	Ref	Ref
	Female	40	10 (25.0)	0.105	2.5 [0.8; 7.3]	3 (7.5)	0.738	0.7 [0.1; 3.1]	0	0.273	0.0
Education level	University	18	1 (5.6)	Ref	Ref	0	Ref	Ref	2 (11.1)	Ref	Ref
	Secondary	27	2 (7.4)	0.808	1.3 [0.1; 16.2]	0	0.998	2.8E8	1 (3.7)	0.352	0.3
	High school	11	1 (9.1)	0.718	1.7 [0.1; 30.2]	5 (45.5)	1.000	1.0	0	0.999	0.0
	Primary	44	13 (29.5)	0.069	7.1 [0.8; 59.2]	4 (9.1)	0.998	2.0E8	0	0.997	0.0
Regular test for STDs	No	34	3 (8.8)	Ref	Ref	2 (5.9)	Ref	Ref	1 (2.9)	Ref	Ref
	Yes	66	14 (21.2)	0.162	2.7 [0.7; 10.4]	7 (10.6)	0.714	1.8 [0.3; 9.6]	2 (3.0)	1.000	1.0 [0.1; 11.7]
Blood transfusion	No	15	3 (20.0)	Ref	Ref	2 (13.3)	Ref	Ref	0	Ref	Ref
	Yes	85	14 (16.5)	0.716	0.7 [0.1; 3.1]	7 (8.2)	0.621	0.5 [0.1; 3.1]	3 (3.5)	1.000	5.9E7
Hepatitis B vaccination	No	95	17 (17.9)	Ref	Ref	9 (9.5)	Ref	Ref	2 (2.1)	Ref	Ref
	Yes	5	0	0.999	0.0	0	1.000	0.0	1 (20.0)	0.064	11.6 [0.8; 156.6]
History of STI	No	77	10 (13.0)	Ref	Ref	7 (9.1)	Ref	Ref	3 (3.9)	Ref	Ref
	Yes	23	7 (30.4)	0.057	2.9 [0.9; 8.8]	2 (8.7)	1.000	0.9 [0.1; 4.9]	0	1.000	0.0
Alcohol intake	No	92	16 (17.4)	Ref	Ref	8 (8.7)	Ref	Ref	3 (3.3)	Ref	Ref
	Yes	8	1 (12.5)	0.725	0.6 [0.1; 5.9]	1 (12.5)	0.543	1.5 [0.1; 13.7]	0	1.000	0.0
Surgical Intervention	No	74	13 (17.6)	Ref	Ref	7 (9.5)	Ref	Ref	3 (4.1)	Ref	Ref
	Yes	26	4 (15.4)	0.799	0.8 [0.2; 2.8]	2 (7.7)	0.787	0.7 [0.1; 4.1]	0	0.998	0.0
Hemodialysis initiation	< 6 months	38	7 (18.4)	Ref	Ref	3 (7.9)	Ref	Ref	1 (2.6)	Ref	Ref
	> 6 months	62	10 (16.1)	0.789	0.8 [0.2; 2.4]	6 (9.7)	0.763	1.2 [0.2; 5.3]	2 (3.2)	0.998	8.2E7

** indicates statistically significant associations; OR: odds ratio; CI: confidence interval

For all other variables, no statistically significant associations were observed (P > 0.05). However, females had a higher percentage of HIV-positive individuals (10/40; 25.0%). For HBV and HCV, no significant differences were observed between sexes.

With respect to education level, participants with primary education had a greater percentage of HIV-positive individuals (13/44; 29.5%, P = 0.069), suggesting a potential association, but this association was not statistically significant. For HBV, no positive results were recorded for university graduates, but a notable percentage (05/11; 45.5%) of high school graduates were positive. Additionally, a history of sexually transmitted infections (STIs) was associated with a greater likelihood of HIV positivity (07/23; 30.4%, P = 0.057), suggesting a potential risk factor. Alcohol intake, surgical intervention and the duration of initiation of hemodialysis were not significantly associated with HIV, HBV, or HCV status, indicating that these factors may not be primary risk factors in this cohort.

Assessment of participants’ knowledge of HIV, HBV and HCV

Overall, participants demonstrated moderate (38%; 38/100) to good (34; 34/100%) knowledge of HIV, HBV, and HCV, whereas 28% (28/100) had poor knowledge of these viral infections. Notably, 99% (99/100) of the participants had heard of HIV, HBV, and HCV, and 35% (35/100) recognized that these infections were caused by viruses. Awareness of the specific targeting of the liver by HBV and HCV was reported by 23% (23/100) of the participants.

With respect to transmission, 44/100 participants acknowledged that the three viruses could be transmitted in a dialysis setting, with 70% (70/100) identifying poor hygiene as a transmission route and 85% (85/100) recognizing blood transfusion as a risk factor. Furthermore, 89% (89/100) believed that these viral infections are preventable, and 38% (38/100) were aware that HBV can be prevented through vaccination. Finally, 72% (72/100) of the participants believed that HIV, HBV, and HCV are treatable (Fig. 2).

Fig. 2.

Participant knowledge of HIV, HBV and HCV

Assessment of healthcare workers’ (HCWs’) infection control practices in the hemodialysis unit

Staff demonstrated adherence to infection control measures during routine practices in the hemodialysis unit of the BRH. Among the 100 hemodialysis sessions observed, all healthcare workers (HCWs) wore personal protective equipment, including gloves and gowns, prior to patient contact. The staff consistently changed gloves before attending to the next patient, and the dialysis machines were regularly cleaned with the recommended detergents. Additionally, HCWs adhere to aseptic techniques when accessing vascular sites and dispose of sharps, such as needles, in designated resistant containers. However, hand hygiene practices are less consistent. Staff practiced hand hygiene after patient contact in only 12% (12/100) of dialysis sessions, using either soap and water or hand sanitizer. While there was strong compliance with several infection control protocols, the low rate of post contact hand hygiene indicates an area for improvement.

General infection control practices in the hemodialysis unit

Several infection control practices were assessed in the hemodialysis unit, highlighting both strengths and weaknesses. Positive aspects included the regular maintenance of dialysis machines, with the most recent service conducted in June 2024. Patients received ongoing education on how to care for their access sites, and staff participated in regular training on infection control practices. Infection control audits are conducted regularly, with the latest audit performed a few months prior. Vaccination against HBV was encouraged for all healthcare workers and patients, and regular testing for HIV, HBV, and HCV was promoted.

However, several negative aspects were identified. There is a lack of dedicated area or equipment for patients with known blood-borne infections, as well as an absence of protocols for managing these cases. Additionally, no surveillance system is in place for monitoring infections within the unit. These findings indicate areas for improvement in infection control practices to increase patient safety.

Discussion

Hemodialysis patients are at increased risk of acquiring blood-borne infections such as HIV, HBV and HCV because of their susceptibility to invasive procedures and their immunosuppressive state. In this study, 29% (29/100) of the population tested positive for at least one of these viral infections among hemodialysis patients at BRH.

The seroprevalence of HIV was reported to be 17.0% (17/100), which is significantly higher than the 2.1% reported in the general population of Cameroon in 2023 [18]. In a similar study conducted in Cameroon in 2017 by Luma et al., the prevalence of anti-HIV antibodies was 13.5% in Buea and Bamenda hemodialysis centers [14], indicating a greater risk for HIV transmission among hemodialysis patients. Among the study participants, 10% (10/100) were known to be HIV-positive prior to initiating hemodialysis. During the study period, an additional 7 patients who had self-reported being HIV-negative at enrollment tested positive, yielding a seroconversion rate of 7.7% (7/90) among those initially HIV-negative. This rate is higher than that reported in similar hemodialysis setting in Cameroon, underscoring the ongoing risk of HIV acquisition in dialysis units [13]. Importantly, the discrepancy between self-reported HIV status and subsequent test results highlights the need for routine confirmatory testing and continuous monitoring of patients in hemodialysis programs.

A lower level of education and a history of STIs were significantly associated with HIV positivity in this cohort. In contrast, a study conducted in Iran reported that less than 1% of patients in hemodialysis centers were HIV positive [19, 20], a difference likely attributable to greater public awareness and stronger infection control practices in those facilities.

The seroprevalence rates of HBV and HCV were 9.0% (09/100) and 3.0% (03/100), respectively, with no investigated factors significantly associated with infection. Similarly, a high HBV prevalence of 10.6% was reported among hemodialysis patients in Cameroon [14]. Studies from various regions, including Iran and Saudi Arabia, reported HBV prevalence rates ranging from 2.1% to 11.0% [9, 11–14] among hemodialysis patients, which is consistent with local epidemiology [19, 21–24].

While the higher prevalence of HCV positivity in the > 60 years age group (02/14; 14.3%) was not statistically significant, it aligns with other studies indicating increased HCV positivity among older individuals, potentially linked to historical vaccination campaigns using unsafe materials [25, 26]. Comparatively, a study in Cameroon reported a much higher anti-HCV antibody prevalence of 19.2% in hemodialysis patients [9]. A meta-analysis of studies performed among hemodialysis patients across different continents revealed a pooled prevalence of 24.3% [27]. The lower prevalence in our study may reflect improved infection control measures in the dialysis unit at BRH.

We found no association between the time of treatment initiation and the three viral infections, suggesting that positivity may be more related to lifestyle factors than to the hemodialysis treatment itself. This finding contradicts previous research by Luma et al., which highlighted a link between higher prevalences of these infections and nonadherence to infection control measures [14].

Beyond prevalence, participants demonstrated moderate to high knowledge of HIV, HBV, and HCV. However, important gaps remain. While 44/100 participants recognized the potential for transmission in a dialysis setting, only 38% were aware that HBV can be prevented through vaccination. This lack of knowledge may hinder efforts to implement effective prevention measures, especially against HBV, for which an effective vaccine is available. The disparity between the proportion of participants who recognized HBV as vaccine-preventable (38%; 38/100) and those who reported receiving the vaccine (5%; 5/100) highlights a critical gap between knowledge and practice. Although our study did not assess the underlying causes, potential explanations include limited vaccine availability, cost barriers, absence of systematic vaccination programs for dialysis patients and healthcare workers, and incomplete awareness of the importance of full vaccine coverage. This gap underscores the need for future research to identify barriers to HBV vaccination uptake and to design targeted interventions that improve coverage in high-risk populations.

Infection control measures in the hemodialysis unit at BRH were generally well followed according to recommended guidelines [12]. However, identified shortcomings, such as ineffective hand hygiene practices due to a lack of running water and the absence of dedicated areas for patients with known bloodborne infections, pose risks. A qualitative study conducted in South Africa identified as well individual-related barriers among hemodialysis practitioners as well as management and organizational barriers to the requirement of infection control practices [10]. Despite encouragement from staff, only 5% of hemodialysis patients are vaccinated against HBV, underscoring the need for enhanced patient education and systematic vaccination programs. These findings highlight the urgent need to strengthen HBV vaccination coverage, improve infection control infrastructure, and promote continuous training of healthcare workers to reduce susceptibility to coinfections in dialysis settings.

This study has several limitations that should be acknowledged. First, the sample size was relatively small and drawn from a single hemodialysis unit, which restricts the generalizability of the findings to other settings or the broader regional population. Second, six patients declined participation, which may have excluded subgroups of epidemiological relevance. Third, data collection relied solely on questionnaires and rapid tests at enrollment, without medical record review or longitudinal follow‑up, limiting our ability to confirm the timeline of infections or assess incident cases. Fourth, although provider practices were observed during 100 hemodialysis sessions, the possibility of observer influence on behavior cannot be excluded; efforts were made to minimize this effect by conducting observations across multiple sessions and staff members. Fifth, because 13 statistical tests were performed without correction for multiple comparisons, there is an increased risk of type I error. Finally, while participants’ knowledge of HIV, HBV, and HCV was assessed, we did not test associations between knowledge scores and infection status. This analysis was beyond the scope of the present study but could provide important insights into whether awareness influences risk behaviors or infection outcomes.

Findings should therefore be interpreted with caution, and future studies with larger sample sizes and adjusted analyses are warranted. Taken together, these factors highlight the need for larger, multi‑center studies with extended follow‑up and more robust observational designs to comprehensively evaluate viral prevalence and transmission risks among patients with chronic kidney disease in Cameroon.

Conclusion

Our findings provide valuable insights into the prevalence and risks associated with HIV, HBV, and HCV among hemodialysis patients. The prevalence rates of 17% for HIV, 9% for HBV, and 3% for HCV highlight significant public health concerns. Addressing gaps in knowledge and improving infection control practices are critical for enhancing patient safety and health outcomes. Promoting HBV vaccination among patients and healthcare workers, strengthening infection prevention and control measures, and ensuring continuous training of dialysis staff are essential steps to reduce transmission risks. These actions, combined with ongoing surveillance and patient education, can contribute to safer hemodialysis services and improved health outcomes in resource‑limited settings.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

HIV

Human Immuno-deficiency Virus

HBV

Hepatitis B Virus

HCV

Hepatitis C Virus

BRH

Buea Regional Hospital

HCW

Health Care Workers

Author contributions

E.H.H.M-E. participated in data collection and curation, performed laboratory testing, and contributed to writing the first draft and critical revision of the manuscript. C.G.M. conceived and designed the study, carried out data curation, performed formal statistical analysis, and critically revised the manuscript. E.N. provided administrative authorization for the research and coordinated the project activities through oversight from the Department of Biomedical Sciences. F.B.A. provided resources for laboratory testing and supervised the diagnostic investigations. D.G.T. contributed to investigation and data collection and provided technical resources in the dialysis unit. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.

Funding

This research received no specific grant from any funding agency.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Authorizations to conduct this research were obtained from the Faculty of Health Sciences (FHS) of the University of Buea, the Buea Regional Hospital, and the Regional Delegation of Public Health (Ref: N° P42/MINSANTE/SWR/RDPH/CB.PT/186/286). Ethical approval was granted by the Institutional Review Board of the Faculty of Health Sciences at the University of Buea (Ref: 2502–04). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

was obtained from all participants prior to data collection. The consent process included a clear explanation of the study objectives, assurance of voluntary participation, respect for the principle of non-maleficence, and guarantees of confidentiality and anonymity. Consent was documented through participants’ signatures at the time of the interview.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.