•Hepatitis B virus infection is the main cause of liver cancer in sub-Saharan Africa.•Little is known about incidence of HBV infection among individuals on antiretroviral therapy.•This is among the first initiatives for liver cancer screening in the region.•Two percent of adults co-infected with human immunodeficiency virus/HBV had significant liver lesions.•One-quarter of patients had findings suggestive of schistosomiasis-induced liver damage. Chronic hepatitis B virus (HBV) infection is the main cause of hepatocellular carcinoma (HCC) in sub-Saharan Africa (SSA). An HCC screening initiative was piloted in an established cohort of individuals co-infected with human immunodeficiency virus (HIV) and HBV on antiretroviral therapy (ART) at two outpatient clinics in Lusaka, Zambia. All patients underwent abdominal ultrasound (AUS) and transient elastography. Among 279 patients co-infected with HIV/HBV, 165 (59.1%) were men, median age was 34 years interquartile range (IQR) 28–39 years and median CD4 count was 246 cells/µL (IQR 112–355 cells/µL) at ART initiation. While 102 (55.7%) individuals had elevated transaminases, 114 (59.7%) had HBV levels >2000 IU/mL and 59 (24.6%) had significant fibrosis. At their first AUS measurement, 75 (26.9%) participants had hepatomegaly and 69 (24.7%) had periportal fibrosis. Five patients had a liver lesion >1 cm, an indication for confirmatory imaging. In one of the first HCC screening initiatives in SSA, 2% of patients co-infected with HIV/HBV had significant liver lesions, and one-quarter had findings suggestive of schistosomiasis-induced liver damage.