Colebunders, RobertAcurio Páez, Fausto DavidVega Crespo, Bernardo JoséOrellana Vintimilla, Daniel AugustoCharry Ramírez, José RicardoGómez, AndreaObimpeh, MichaelVerhoeven, Veronique2022-02-112022-02-1120211661-7827http://dspace.ucuenca.edu.ec/handle/123456789/38040https://www.scopus.com/inward/record.uri?eid=2-s2.0-85104790238&doi=10.3390%2fijerph18094657&partnerID=40&md5=2b9a8a59caae8f1c65959bd7b9d5fa79A door-to-door survey was organised in Cuenca, Ecuador, to determine the prevalence ofCOVID-19 infection and adherence of the population to COVID-19 preventive measures. A total of2457 persons participated in the study; 584 (23.7%) reported having experienced at least one flu-likesymptom since the onset of the pandemic. The maximum SARS-CoV-2 seroprevalence in Cuenca was13.2% (CI: 12–14.6%) (IgM or IgG positive). Considering PCR confirmed infections, the prevalencewas 11% (CI: 10–12.4%). There was no significant difference in seroprevalence between rural andurban areas. Participants aged 35–49 years old, living with a COVID-19 positive person, at leastsix people in a household, physical contact with someone outside the household, a contact with aperson outside the home with flu-like symptoms, using public transport, and not having enoughresources for living, significantly increased the odds for SARS-CoV-2 seropositivity. Overall, therewas good adherence to COVID-19 preventive measures. Having known someone who tested positivefor COVID-19, having a primary or secondary level of education, and having enough resources forliving, significantly increased the odds for higher adherence. In conclusion, despite good overalladherence of the population of Cuenca with COVID-19 preventive measures, our study suggests highongoing COVID-19 transmission in Cuenca, particularly in certain parishes. Prevention should notonly focus on behavioural change, but on intensified testing strategies in demographical risk groupses-ESAdherencePreventive measuresPrevalencePCR testIgM antibodiesEcuadorCOVID-19IgG antibodiesARTÍCULO10.3390/ijerph18094657