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The limiting assumptions of ITT analyses in cluster randomised trials and the mobility of mosquitoes and humans across cluster boundaries indicate the primary analysis is likely to underestimate the full public health benefit. Using spatiotemporally-resolved data on the distribution of\n                    <jats:italic>Wolbachia<\/jats:italic>\n                    mosquitoes and on the mobility of AWED participants (n = 6306), we perform complier-restricted and per-protocol re-examinations of the efficacy of the\n                    <jats:italic>Wolbachia<\/jats:italic>\n                    intervention. Increased intervention efficacy was estimated in all analyses by the refined exposure measures. The complier-restricted analysis returned an estimated efficacy of 80.7% (95% CI 65.9, 89.0) and the per-protocol analysis estimated 82.7% (71.7, 88.4) efficacy when comparing participants with an estimated\n                    <jats:italic>w<\/jats:italic>\n                    Mel exposure of\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$\\ge$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mo>\u2265<\/mml:mo>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    80% compared to those with &lt;20%. These reanalyses demonstrate how human and mosquito movement can lead to underestimation of intervention effects in trials of vector interventions and indicate that the protective efficacy of\n                    <jats:italic>Wolbachia<\/jats:italic>\n                    is even higher than reported in the primary trial results.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-60896-9","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T07:02:24Z","timestamp":1715842944000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Reanalysis of cluster randomised trial data to account for exposure misclassification using a per-protocol and complier-restricted approach"],"prefix":"10.1038","volume":"14","author":[{"given":"Suzanne M.","family":"Dufault","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie K.","family":"Tanamas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Citra","family":"Indriani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riris Andono","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adi","family":"Utarini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas P.","family":"Jewell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron P.","family":"Simmons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L.","family":"Anders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"60896_CR1","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1016\/j.cell.2009.11.042","volume":"139","author":"LA Moreira","year":"2009","unstructured":"Moreira, L. A. et al. A Wolbachia symbiont in Aedes aegypti limits infection with dengue, chikungunya, and plasmodium. Cell 139, 1268\u20131278 (2009).","journal-title":"Cell"},{"key":"60896_CR2","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1038\/nature10355","volume":"476","author":"T Walker","year":"2011","unstructured":"Walker, T. et al. The wMel Wolbachia strain blocks dengue and invades caged Aedes aegypti populations. Nature 476, 450\u2013453 (2011).","journal-title":"Nature"},{"key":"60896_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/srep28792","volume":"6","author":"MT Aliota","year":"2016","unstructured":"Aliota, M. T., Peinado, S. A., Velez, I. D. & Osorio, J. E. The wMel strain of Wolbachia reduces transmission of Zika virus by Aedes aegypti. Sci. Rep. 6, 1\u20137 (2016).","journal-title":"Sci. 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Update to the AWED (Applying Wolbachia to Eliminate Dengue) trial study protocol: A cluster randomised controlled trial in Yogyakarta, Indonesia. Trials 21, 1\u20135. https:\/\/doi.org\/10.1186\/s13063-020-04367-2 (2020).","journal-title":"Trials"},{"key":"60896_CR11","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.4269\/ajtmh.18-0315","volume":"99","author":"C Indriani","year":"2018","unstructured":"Indriani, C. et al. Baseline characterization of dengue epidemiology in Yogyakarta city, Indonesia, before a randomized controlled trial of Wolbachia for arboviral disease control. Am. J. Trop. Med. Hyg. 99, 1299 (2018).","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"60896_CR12","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1093\/biostatistics\/kxy005","volume":"20","author":"NP Jewell","year":"2019","unstructured":"Jewell, N. P., Dufault, S., Cutcher, Z., Simmons, C. P. & Anders, K. L. 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