Cascades of effectiveness of new-generation insecticide-treated nets against malaria, from entomological trials to real-life conditions

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Abstract As insecticide resistance spreads in Africa, new-generation insecticide-treated nets (ITNs) are increasingly being deployed to protect vulnerable populations against malaria. While these nets provide greater entomological efficacy against resistant mosquitoes, their effectiveness against malaria transmission also depends on other factors, such as durability, access, usage, and activity patterns of hosts and vectors. Here, we quantify the impact of two new-generation ITNs, namely Interceptor®G2 (chlorfenapyr-pyrethroid) and Olyset®Plus (piperonyl butoxide-pyrethroid), in a cascade from entomological efficacy to population-level effectiveness. We use a mathematical model that we parameterize with entomological data and validate against results from randomized controlled trials. We found that, beyond entomological factors, operational factors including functional survival, ITN use and in-bed exposure critically impact ITN effectiveness overall and per ITN types. Our results obtained for Tanzania can be extended to other contexts in a dashboard ( https://aimswisstph.shinyapps.io/ITNcascadesdashboard ) allowing users to explore product selection based on setting-specific factors that influence ITN effectiveness.

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