{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T19:00:49Z","timestamp":1791140449184,"version":"4.1.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U19 AI089674"],"award-info":[{"award-number":["U19 AI089674"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["ROC05796365MD"],"award-info":[{"award-number":["ROC05796365MD"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-017894"],"award-info":[{"award-number":["INV-017894"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Long-lasting insecticidal nets (LLINs) are the cornerstone of malaria control, but their effectiveness is threatened by pyrethroid resistance. We embedded a pragmatic, cluster-randomised trial into Uganda\u2019s national LLIN distribution campaign in 2020\u20132021, comparing pyrethroid-piperonyl butoxide (PBO) LLINs to pyrethroid-pyriproxyfen LLINs. Target communities surrounding public health facilities (clusters, n=64), covering 32 districts were included. Clusters were randomised 1:1 in blocks of two by district to receive: (1) pyrethroid-PBO LLINs (PermaNet 3.0, n=32) or (2) pyrethroid-pyriproxyfen LLINs (Royal Guard, n=32). LLINs were delivered from 7 November 2020 to 26 March 2021. Malaria surveillance data were collected from health facilities from 1 November 2019 until 31 March 2023. Cluster-level estimates of malaria incidence in residents of all ages (primary outcome) were generated from enhanced health facility surveillance data. Cross-sectional community surveys were conducted in randomly selected households (at least 50 per cluster) at 12-months (24 November 2021 to 1 April 2022) and 24-months (23 November 2022 to 21 March 2023) post-LLIN distribution. Overall, 186,364 clinical malaria episodes were diagnosed in cluster residents during 398,931 person-years of follow-up. At 24-months, malaria incidence was lower than baseline in both arms (pyrethroid-PBO: 465 vs 676 episodes per 1000 person-years; pyrethroid-pyriproxyfen: 469 vs 674 episodes per 1000 person-years); but there was no evidence of a difference between the arms (incidence rate ratio 1.06, 95% confidence interval [CI] 0.91\u20131.22, p=0.47). Two years post-distribution, ownership of at least one LLIN for every two household residents was low in both arms (41.1% pyrethroid-PBO vs 38.6% pyrethroid-pyriproxyfen). Parasite prevalence in children aged 2-10 years was no different between the arms in either survey (24-months: 26.1% pyrethroid-PBO; 29.5% pyrethroid-pyriproxyfen; odds ratio 1.29 [95% CI: 0.81\u20132.05], p=0.29). The effectiveness of pyrethroid-PBO LLINs and pyrethroid-pyriproxyfen LLINs was no different in Uganda, but two years after mass distribution, LLIN coverage was inadequate.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial registration<\/jats:bold>\n                    : NCT04566510. Registered 28 September 2020,\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04566510\" xlink:type=\"simple\">\n                      <jats:underline>https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04566510<\/jats:underline>\n                    <\/jats:ext-link>\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0003558","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T13:36:58Z","timestamp":1740577018000},"page":"e0003558","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["LLIN Evaluation in Uganda Project (LLINEUP2) \u2013 Effect of long-lasting insecticidal nets (LLINs) treated with pyrethroid plus pyriproxyfen vs LLINs treated with pyrethroid plus piperonyl butoxide in Uganda: A cluster-randomised trial"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4865-0718","authenticated-orcid":true,"given":"Samuel","family":"Gonahasa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Frances","family":"Namuganga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha J.","family":"Nassali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Maiteki\u2011Sebuguzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaiah","family":"Nabende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Epstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-2720","authenticated-orcid":true,"given":"Katherine","family":"Snyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-3845","authenticated-orcid":true,"given":"Joaniter I.","family":"Nankabirwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Opigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Donnelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Dorsey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-4234","authenticated-orcid":true,"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah G.","family":"Staedke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"issue":"7572","key":"pgph.0003558.ref001","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/nature15535","article-title":"The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015","volume":"526","author":"S Bhatt","year":"2015","journal-title":"Nature"},{"key":"pgph.0003558.ref002","volume-title":"World Malaria Report 2023","author":"World Health Organization","year":"2023"},{"key":"pgph.0003558.ref003","volume-title":"Uganda Malaria Indicator Survey 2018-19","author":"Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS), ICF","year":"2020"},{"issue":"1","key":"pgph.0003558.ref004","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1038\/s41467-021-22896-5","article-title":"The impact of stopping and starting 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