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Assessing the prevalence and risk factors for HIV and HCV in marginalized populations in Madrid.

March 23, 2026Open Access

HIV/HCV prevalence and the retention paradox in marginalized populations in Madrid (2019–2023): A large-scale cross-sectional study

Key Points

Assessing the prevalence and risk factors for HIV and HCV in marginalized populations in Madrid.
Conducted a cross-sectional study in Madrid from 2019 to 2023.
Included 4,582 individuals from high-risk hotspots.
Performed rapid HIV/HCV testing and confirmed HCV-RNA via point-of-care testing.
Utilized multivariable logistic regression to identify HIV risk factors.
HIV prevalence was found to be 6.3%, with 17.0% of people with HIV not receiving treatment.
Active HCV prevalence was 5.5%, with significantly higher rates in people with HIV (15.7%).
Notably, 16.8% of all antibody-positive individuals did not receive confirmatory RNA testing.

Abstract

Background: 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 4,582 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 HIVnegative individuals.A history of injecting drug use was the primary HIV risk factor (adjusted odds ratioaOR 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.

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