International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
HIV/HCV prevalence and the retention paradox in marginalized populations in Madrid (2019-2023): A large-scale cross-sectional study.
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Valencia Jorge, Ryan Pablo, Codina Helena, Cuevas Guillermo, Manzano Samuel, Estévez Samuel, Martínez Isidoro, Sepúlveda-Crespo Daniel, Resino Salvador
Аннотация
OBJECTIVES: Marginalized urban populations experience a high burden of HIV and HCV. We assessed the prevalence and risk factors for both infections and characterized the care cascades in a cohort of vulnerable individuals in Madrid, Spain.
METHODS: We conducted a cross-sectional study (2019-2023) of 4582 individuals via mobile units in high-risk hotspots, offering integrated rapid HIV/HCV testing with point-of-care HCV-RNA confirmation. Multivariable logistic regression identified independent HIV risk factors.
RESULTS: HIV prevalence was 6.3% (95% CI: 5.6-7.0). Among people with HIV (PWH), 17.0% of known cases were not receiving antiretroviral therapy; PrEP uptake was zero among HIV-negative individuals. A history of injecting drug use was the primary HIV risk factor (adjusted odds ratio[aOR] 6.6; 95% CI: 4.6-9.5), followed by age >50 years, Spanish origin, and alcohol/benzodiazepine misuse (all P < 0.05). Active HCV prevalence was 5.5% (95% CI: 4.9-6.2); 15.7% in PWH vs 4.8% in people without HIV (P < 0.001). Among confirmed cases, HCV linkage (≥95.2%) and treatment (≥88.6%) were high; however, 16.8% of all antibody-positive individuals (23.2% among PWH) missed confirmatory RNA testing.
CONCLUSIONS: HIV and HCV remain prevalent, characterized by discontinuities in retention rather than diagnosis. Integrated, low-threshold strategies combining harm reduction with social support are required to address this syndemic.
METHODS: We conducted a cross-sectional study (2019-2023) of 4582 individuals via mobile units in high-risk hotspots, offering integrated rapid HIV/HCV testing with point-of-care HCV-RNA confirmation. Multivariable logistic regression identified independent HIV risk factors.
RESULTS: HIV prevalence was 6.3% (95% CI: 5.6-7.0). Among people with HIV (PWH), 17.0% of known cases were not receiving antiretroviral therapy; PrEP uptake was zero among HIV-negative individuals. A history of injecting drug use was the primary HIV risk factor (adjusted odds ratio[aOR] 6.6; 95% CI: 4.6-9.5), followed by age >50 years, Spanish origin, and alcohol/benzodiazepine misuse (all P < 0.05). Active HCV prevalence was 5.5% (95% CI: 4.9-6.2); 15.7% in PWH vs 4.8% in people without HIV (P < 0.001). Among confirmed cases, HCV linkage (≥95.2%) and treatment (≥88.6%) were high; however, 16.8% of all antibody-positive individuals (23.2% among PWH) missed confirmatory RNA testing.
CONCLUSIONS: HIV and HCV remain prevalent, characterized by discontinuities in retention rather than diagnosis. Integrated, low-threshold strategies combining harm reduction with social support are required to address this syndemic.