Hepatitis B Lurks Among Long-Haul Truckers at a Busy Tanzanian Border Post

At the Tunduma One-Stop Border Post, a chokepoint on the highway corridor linking Tanzania to Zambia and the wider Southern African transport network, thousands of long-distance truck drivers pass through every month. These drivers spend weeks or months away from home, crossing borders and sleeping in roadside settlements where healthcare is often scarce and preventive services scarcer still. A new cross-sectional study published in BMC Infectious Diseases by Shadrack Moses of KCMC University and colleagues has now quantified one of the hidden health risks of this mobile profession: infection with hepatitis B virus, a pathogen that silently attacks the liver and remains one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. The researchers found that 6.6 percent of the drivers they screened carried detectable hepatitis B surface antigen in their blood, a marker of active infection, and that two specific features of the trucking lifestyle stood out as independent predictors of that positivity.

The study enrolled 396 long-distance truck drivers aged 18 years and older at the Tunduma border crossing in Songwe Region, southwestern Tanzania. Participants answered a structured questionnaire administered through the Kobo Toolbox digital platform, covering sociodemographic characteristics, sexual behaviour, occupational history, and health-related factors. Each participant then provided a blood sample, which was tested for hepatitis B surface antigen using the Abbott Determine rapid diagnostic test, a widely deployed immunochromatographic assay that detects the viral surface protein circulating in serum or plasma. The research team analysed the data using bivariate and multivariable logistic regression, reporting adjusted odds ratios with 95 percent confidence intervals to identify which factors remained independently associated with infection after accounting for confounders.

The headline number from the study is a prevalence of 6.6 percent, with a 95 percent confidence interval of 4.3 to 9.5 percent. In absolute terms, 26 of the 396 drivers tested positive for hepatitis B surface antigen. The participants had a median age of 37.5 years with an interquartile range of 13 years, and the overwhelming majority, 308 drivers or 77.8 percent, were married. That a substantial fraction of a largely married, adult male workforce carries an active hepatitis B infection has implications well beyond the individuals concerned, because hepatitis B virus is efficiently transmitted through sexual contact, contaminated blood, and perinatal exposure, meaning an untreated infection in a mobile worker can seed new infections in partners and communities along transport corridors.

Hepatitis B virus itself is a partially double-stranded DNA hepadnavirus that targets hepatocytes, the working cells of the liver. After exposure, the virus can establish a chronic infection, particularly when acquired in childhood, and chronic carriers face a lifelong elevated risk of progressive liver fibrosis, cirrhosis, and primary liver cancer. The presence of hepatitis B surface antigen in the blood is the standard screening marker for current infection, distinguishing carriers from people who have cleared the virus or been vaccinated. In sub-Saharan Africa, where the virus is highly endemic and much transmission occurs early in life, prevalence in the general population frequently exceeds the 1 percent threshold that defines high endemicity by a wide margin, and the World Health Organization has made the elimination of viral hepatitis as a public health threat a global target. Yet screening, vaccination coverage, and linkage to antiviral therapy remain patchy across much of the region, and certain occupational groups fall through the cracks of routine health services.

Long-distance truck drivers have long been recognised in epidemiological literature as a bridge population for sexually transmitted infections, including HIV, because of prolonged separation from regular partners, the availability of commercial sex along transport routes, and limited access to consistent healthcare. What the Tunduma study adds is specific, quantified evidence that the same dynamics apply to hepatitis B. In the multivariable analysis, drivers who reported having more than five sexual partners in the previous 12 months had 2.78 times the odds of hepatitis B surface antigen positivity compared with those reporting five or fewer partners, with a 95 percent confidence interval of 1.120 to 6.901 and a p-value of 0.028. This association held after adjustment for other measured variables, strengthening the inference that high partner numbers, rather than some correlated characteristic, drive the excess risk.

The second independent predictor was occupational in nature. Drivers whose transit time exceeded 60 days had 4.62 times the odds of testing positive compared with drivers whose trips lasted between 0 and 30 days, with a 95 percent confidence interval of 1.707 to 12.520 and a p-value of 0.003. Transit time serves as a composite proxy for cumulative exposure on the road: the longer a driver remains away from home, the more border crossings, roadside contacts, and opportunities for unprotected sexual encounters accumulate, and the less likely it is that the driver encounters vaccination or screening services. The magnitude of this association, nearly a fivefold increase in odds, suggests that the structural rhythm of long-haul work itself, not merely individual behaviour, shapes infection risk in this population.

The authors emphasise that these findings point toward concrete, implementable interventions. Strengthening hepatitis B vaccination programmes, expanding screening and confirmatory testing, and building reliable linkage to appropriate clinical care at border posts and other major transport hubs could substantially improve prevention and early detection among mobile workers. Hepatitis B vaccination is highly effective, inducing protective antibodies against the surface antigen in more than 95 percent of healthy adults after a standard three-dose schedule, and vaccinating adults in high-exposure occupations is a recognised strategy in endemic settings. Because the Tunduma study used a rapid diagnostic test as its primary screening tool, positive results would in routine practice require confirmatory testing, and the study protocol itself included counselling and referral of positive participants to health facilities for further evaluation and management, a model that could be institutionalised at border clinics.

The study’s design carries both strengths and limitations worth noting. As a cross-sectional survey, it captures a snapshot of infection status and self-reported behaviour at a single point in time, which means it can identify associations but cannot definitively establish temporal direction; for example, a long transit time may reflect either greater exposure or the characteristics of drivers who take the longest routes. Behavioural data on sexual partners rely on self-report, which is vulnerable to social desirability bias, particularly on sensitive topics. The rapid diagnostic test, while practical for field conditions, has imperfect sensitivity and specificity compared with laboratory-based immunoassays, and the authors appropriately recommend confirmatory testing where indicated. The sample of 396 drivers, however, provides reasonable statistical power, and the multivariable regression framework adjusted for potential confounders in estimating the independent effects of partner number and transit time.

Ethically, the study was approved by the KCMC University Research Ethics Review Committee under approval number UG 65/2026, with permission from the Tunduma Border Hospital administration, and written informed consent was obtained from all participants. Participant information and specimens were handled confidentially using unique study identification numbers, and results were communicated to participants through appropriate confidential channels. Drivers who tested positive were counselled and referred for confirmatory testing and clinical management, while those who tested negative received information on hepatitis B prevention. The research followed the ethical principles of the Declaration of Helsinki, and the authors declared no competing interests and received no external funding for the work.

The broader significance of the Tunduma findings lies in what they reveal about the geography of infectious disease risk. Border posts are not merely administrative checkpoints; they are nodes where mobile populations, commercial networks, and health systems intersect, often at the exact points where health services are weakest. By documenting a 6.6 percent prevalence of active hepatitis B infection among truck drivers and identifying modifiable correlates of that risk, the study gives Tanzanian health authorities and their regional partners a data-driven rationale for embedding hepatitis services into the transport infrastructure itself. If vaccination, screening, and care linkage can be delivered where long-haul drivers actually work, at the border posts and rest stops that define their professional lives, the study suggests that a highly mobile and historically underserved population could be reached with interventions that protect both the drivers and the communities their routes connect.

Subject of Research: Prevalence and risk factors of hepatitis B virus infection among long-distance truck drivers at a Tanzanian border post

Article Title: Prevalence of hepatitis B surface antigen and associated factors among long-distance truck drivers at the Tunduma One-Stop Border Post, Tanzania: a cross-sectional study at Tunduma, Tanzania

Article References: Moses, S., Mwakanyamale, D. A., Magombi, L. J., Felician, F. F., Issangya, E. T., & Kajeguka, D. C. (2026). Prevalence of hepatitis B surface antigen and associated factors among long-distance truck drivers at the Tunduma One-Stop Border Post, Tanzania: a cross-sectional study at Tunduma, Tanzania. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14612-9

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14612-9

Keywords: hepatitis B, hepatitis B surface antigen, long-distance truck drivers, Tanzania, border post, prevalence, risk factors, viral hepatitis, occupational health, cross-sectional study, public health, sub-Saharan Africa