Effectiveness of the standardized strategy for prevention of mother-to-child transmission of human immunodeficiency virus in Ecuador

doi:10.5528/wjtm.120643

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World Journal of Translational Medicine

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2220-6132

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transl Med. Jul 28, 2026; 12(2): 120643
Published online Jul 28, 2026. doi: 10.5528/wjtm.120643

Effectiveness of the standardized strategy for prevention of mother-to-child transmission of human immunodeficiency virus in Ecuador

Doménica D Villacís-Ponce, Alexandra I Andrade-Nieto

Doménica D Villacís-Ponce, School of Medicine, San Gregorio de Portoviejo University, Portoviejo 130101, Manabí, Ecuador

Alexandra I Andrade-Nieto, Neonatology Service, Dr. Teodoro Maldonado Carbo Specialty Hospital, Guayaquil 090203, Guayas, Ecuador

Author contributions: Villacís-Ponce DD and Andrade-Nieto AI contributed to the investigation, patient recruitment and follow-up coordination, data curation and verification, interpretation of the results, and critical review and editing of the manuscript; Villacís-Ponce DD additionally conceived and designed the study, developed the study methodology, performed the formal analysis, prepared the original draft of the manuscript, supervised the overall research process, managed the project, and contributed substantially to the intellectual content of the study and the final version of the manuscript; Andrade-Nieto AI additionally validated the dataset, prepared the visual materials, and provided essential resources for study execution.

AI contribution statement: The initial translation of this research manuscript into English was performed using the AI tool Copilot. The translated text was then carefully reviewed and verified by one of the authors with advanced English proficiency. The QuillBot extension for Chrome was subsequently used to refine punctuation according to standard grammatical conventions. Finally, Copilot was used to format the references in the style required by the journal, as the original Spanish version of the manuscript followed American Psychological Association guidelines. All other aspects of the work, including the development of the introduction, methods, results, analysis, and conclusions, were produced entirely by the authors. These sections reflect 6 years of dedicated work in the prevention of the mother-to-child transmission of human immunodeficiency virus. The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Institutional review board statement: This retrospective study was approved by the Ethics Committee of Hospital de Especialidades Teodoro Maldonado Carbo (Approval No. IESS-HTMC-JACMI-2024-0224-M). The approval authorized the use of fully anonymized maternal and neonatal clinical data for research, epidemiological analysis, and quality improvement purposes, in accordance with national confidentiality regulations and the ethical principles of the Declaration of Helsinki.

Informed consent statement: The study used anonymized retrospective clinical records generated during routine care within the national prevention of mother-to-child transmission program. According to institutional policy and the Ethics Committee’s determination, the requirement for individual informed consent was waived because the research involved no direct patient contact, no additional procedures, and no identifiable information. The institution maintains a standardized informed consent form for the use of clinical information in research, which outlines confidentiality safeguards and voluntary authorization; however, for this retrospective analysis, the Ethics Committee confirmed that a waiver of informed consent was appropriate.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The clinical data used in this study originate from confidential institutional medical records and cannot be publicly shared because of national regulations and Ecuadorian Social Security Institute data protection policies. De-identified data may be made available upon reasonable request to the corresponding author and with prior approval by Hospital de Especialidades “Dr. Teodoro Maldonado Carbo.”

Corresponding author: Doménica D Villacís-Ponce, MD, Professor, Researcher, School of Medicine, San Gregorio de Portoviejo University, Avenida Metropolitana y Avenida Olímpica, Portoviejo 130101, Manabí, Ecuador. ddvillacis@sangregorio.edu.ec

Received: March 4, 2026
Revised: June 6, 2026
Accepted: July 9, 2026
Published online: July 28, 2026
Processing time: 147 Days and 8.2 Hours

Abstract

BACKGROUND

Mother-to-child transmission of human immunodeficiency virus (HIV) remains a significant public health challenge in Latin America. In Ecuador, national reports indicate that vertical transmission rates continue to exceed the elimination threshold, underscoring the need for consistent implementation of standardized prevention strategies.

AIM

To evaluate the effectiveness of Ecuador’s standardized strategy for prevention of mother-to-child transmission of HIV during 2017-2023.

METHODS

This retrospective study analyzed clinical records and notification forms of all HIV-exposed infants enrolled in the institutional prevention program. Data included sex, maternal risk classification, neonatal prophylaxis, virologic follow-up, and serologic testing at 18 months. Infants were categorized as HIV-positive, HIV-negative, seroreverters, under evaluation, or lost to follow-up. The vertical transmission incidence was calculated among infants with complete diagnostic evaluation. All procedures adhered to institutional and national ethical standards for the use of anonymized clinical data.

RESULTS

In total, 320 HIV-exposed infants were included. Two infants were diagnosed with HIV infection, resulting in a vertical transmission rate of 0.65% (2/309; 95% confidence interval: 0.18%-2.35%) after excluding infants lost to follow-up. Most infants (91.3%) were confirmed HIV-negative before 6 months of age, and 265 achieved seroreversion at 18 months. The observed transmission rate was substantially lower than the national estimate of 2.07%, reflecting the effectiveness of the standardized prevention strategy.

CONCLUSION

The standardized strategy for prevention of mother-to-child transmission achieved a very low vertical HIV transmission rate, and underscoring the importance of consistent maternal treatment and neonatal prophylaxis.

Keywords: Human immunodeficiency virus; Mother-to-child transmission; Neonatal prophylaxis; Antiretroviral therapy; Ecuador

Core Tip: This study shows that a rigorously implemented, standardized national strategy for prevention of mother-to-child transmission of human immunodeficiency virus can achieve a vertical transmission rate of 0.65% in a real-world Ecuadorian setting. The findings highlight the importance of early maternal diagnosis, consistent antiretroviral therapy, and coordinated maternal-infant follow-up to sustain progress toward national elimination goals.