High screening coverage and positivity rates of HIV, syphilis, and hepatitis B among pregnant women accessing antenatal care in Sierra Leone.

BACKGROUND: Sierra Leone faces high rates of mother-to-child transmission (MTCT) of HIV, syphilis, and presumed hepatitis B (HepB). Since 2014, integrated testing and treatment within antenatal care (ANC) have aimed to prevent this transmission, yet no comprehensive study on these infections among pregnant women exists. OBJECTIVES: Assess screening coverage and test positivity for these infections in 21 health facilities in 4 districts, each representing Sierra Leone's four regions, to ensure national representation of triple elimination testing: Primary (12), Secondary (5), and Tertiary (4). METHOD: A cross-sectional analysis of secondary data from health-facility registers in Western Area Urban, Bombali, Bo, and Kenema districts, between November 2024 and October 2025, summarised as frequencies and proportions. RESULTS: Among 10,003 women attending their first ANC visit, screening coverage was 99.6% for HIV, 99.6% for syphilis, 92.9% for HepB, and 92.4% for all three infections. Test positivity was 4.9% for HIV, 1.3% for syphilis, and 4.0% for HepB. CONCLUSION: Triple-disease testing at ANC facilities in Sierra Leone is feasible and can achieve high coverage. The test-positivity rate for HepB suggests a considerable burden of maternal infection and ongoing MTCT. Still, there are currently no interventions to address this gap. Testing should be scaled-up urgently and followed by a programme for maternal treatment, safe delivery, and immunisation.