OBJECTIVES: WHO hepatitis B (HbsAg) guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for HbsAg with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of HbsAg screening and management of patients with HbsAg and HIV con-infection after the implementation.METHODS: Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test.Statistical analysis was performed using STATA version 13.The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml.RESULTS: Number of HbsAg tests done increased from 800 in 2012 to 1400 in 2015 with a total of, 8042/8604(93.5%) patients screened . Overall HbsAg positive were; 359 (4.6%), male 189 (52.6%), median age 38 (32, 45), on ART337 (93.9%) with a median time on ART 74 (27, 399) days.166 (81.4%) HbsAg positives were switched to a Tenofovir containing regimen. Of those not switched, 8(36.4%) died, 4(18.2%) discontinued care, 7(31.8%) had been transferred out. Overall 23 (6.5%) HbsAg positives died. Patients with ASTs done were 86(24%), 7(1.9%) had HbsAg viral loads and 250(69.6%) patients with an ultra sound scan done.CONCLUSIONS: Our study documents the improvements outcomes of an improved Hepatitis B screening regimen in a busy HIV clinic in sub-Saharan Africa. With training and resources we were able to screen >90% of our population. Improvement could still be made with appropriate ART and follow up for those who are Hepatitis B HIV co-infected