Temporal changes in the prevalence of active HCV infection among people at risk of social exclusion in Seville.

BACKGROUND AND AIMS: achieving hepatitis C virus (HCV) elimination by 2030, as proposed by the WHO, remains particularly challenging in vulnerable populations. Monitoring the prevalence of HCV infection in this setting is crucial to assess progress toward elimination. We aimed to evaluate changes in the serial prevalence of active HCV infection among individuals at risk of social exclusion in an area where multiple HCV micro-elimination initiatives have been implemented. METHODS: we conducted a serial cross-sectional study in two periods (2022-2023 and 2025) across social support resources, including homeless shelters, addiction treatment centers, and inclusion centers. Participants underwent point-of-care anti-HCV screening, followed by HCV RNA testing in seropositive individuals. RESULTS: a total of 573 individuals were screened in the first phase and 570 in the second. Anti-HCV prevalence remained stable (11.17% vs. 10.53%; p=0.724). The prevalence of active HCV infection was 1.92% (95% CI: 0.80%-3.04%) in the first period and 0.88% (95% CI: 0.11%-1.64%) in the second (p=0.149). Nine (15%) of the seropositive individuals in 2025 were unaware of their serostatus. All viremic individuals identified in the second phase had been previously diagnosed but only one had started treatment, which was not completed. CONCLUSIONS: although the prevalence of active HCV infection showed a numerical decrease, it persists at significant levels among socially excluded populations. Current micro-elimination efforts have been partially effective but insufficient to address the residual reservoir of infection. Novel tailored strategies focusing on linkage to care for hard-to-reach individuals are required.