[Contact with nature and its relationship with perceived stress and health-related quality of life in rural adults served by primary care].

According to estimates from the World Health Organization (WHO), ~ 254 million people (3.3% of the global population) were living with HBV with 1.2 million new infections and ~ 1.1 million deaths annually in 2022, mostly from cirrhosis and hepatocellular carcinoma. Geographically, the burden of infection is highest in the WHO Western Pacific Region (~ 97 million cases) and the WHO African Region (~ 65 million cases) []. Ethiopia, where HBV is highly endemic, is among the ten countries accounting for two-thirds of the global viral hepatitis burden [], and the national HBV prevalence is estimated at 7%, with individual estimates ranging from 2.6% among female sex workers to 11% among immigrants [, ]. Furthermore, chronic HBV is the leading cause of chronic liver disease, responsible for 40% of cases and, along with hepatitis C (17%) and alcohol-related liver disease (15%), contributes to 25% of all-cause in-hospital mortality []. Given the high burden of HBV infection, achieving the WHO goal of hepatitis elimination by 2030, which targets a 90% reduction in new cases and a 65% reduction in liver-related mortality, will require innovative approaches, with targeted screening of high-risk population and increasing uptake of HBV treatment [–]. Disclosure of serostatus is a continuous social and psychological, context-dependent process influenced by anticipated stigma, prior experiences, and perceived benefits [] and the disclosure event is a goal‑directed interpersonal communication in which previously concealed health information is shared with a specific target such as sexual partner, family member, employer, or health worker [–]. For hepatitis B, disclosure of serostatus can be conceptualized by adapting the disclosure processes model and related human immune deficiency virus (HIV) disclosure theories, where HBV positive adults develop approach goals such as protecting partners from infection, gaining social support, improving adherence and linkage to care and avoidance goals such as fear of stigma, relationship loss, blame, or violence, which shape whether, when, how, and to whom they disclose their status [–, ].