Abstract
BACKGROUND: Trauma is among the leading causes of death and disability in Malawi and accounts for a substantial proportion of emergency admissions at tertiary hospitals. However, injured patients presenting for trauma care are infrequently screened for blood-borne viral infections, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), resulting in missed opportunities for diagnosis and linkage to care. This study assessed the feasibility of finding new cases of HBV, HCV, and HIV among injured adult patients who presented to Queen Elizabeth Central Hospital (QECH) and evaluated the acceptability of provider-initiated opt-in testing. METHODS: We conducted a cross-sectional study from October to November 2021 among injured adults (n = 63) seeking trauma care at the Adult Emergency and Trauma Centre (AETC) of QECH in Blantyre, Malawi. Demographic data, risk factors, and injury characteristics were collected. Blood samples were tested for HBV, HCV, and HIV using SD BIOLINE HBsAg, Rapid Anti-HCV, and Determine HIV-1/2 rapid test kits, respectively and confirmed with enzyme-linked immunosorbent assay (ELISA). Case detection rate and testing acceptability were expressed as proportions. RESULTS: Of the 94 patients who were approached during the study period, 63 consented to participate in the study, representing a 67.02% acceptability of testing. Road traffic accident–related injuries accounted for 36.5% (n = 23) of the presentations, whereas non-traffic-related accidents accounted for the other 63.5%. Most refusals to participate in the study were due to fear of further blood loss and reluctance to undergo HIV testing. We found a total of 14 positive HIV cases within our study population, out of which 6 were newly diagnosed. Moreover, all cases of HBV (3 cases) and HCV (2 cases) were newly identified as well. HBV and HIV co-infection was observed in one participant. CONCLUSION: A considerable proportion of injured patients presenting to the AETC had undiagnosed blood-borne viral infections, with reasonably high acceptability of testing. Incorporating routine HBV, HCV, and HIV provider-initiated testing into trauma care settings could improve early detection, linkages to care, and infection prevention strategies. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-026-13120-0.