{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T02:15:40Z","timestamp":1773454540937,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010150","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000}}],"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1053230 via Coalition for Operational Research on Neglected Tropical Diseases"],"award-info":[{"award-number":["OPP1053230 via Coalition for Operational Research on Neglected Tropical Diseases"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["through Neglected Tropical Diseases Program"],"award-info":[{"award-number":["through Neglected Tropical Diseases Program"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK aid"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The Transmission Assessment Survey (TAS) is a decision-making tool to determine when transmission of lymphatic filariasis is presumed to have reached a level low enough that it cannot be sustained even in the absence of mass drug administration. The survey is applied over geographic areas, called evaluation units (EUs); existing World Health Organization guidelines limit EU size to a population of no more than 2 million people.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>In 2015, TASs were conducted in 14 small EUs in Haiti. Simulations, using the observed TAS results, were performed to understand the potential programmatic impact had Haiti chosen to form larger EUs. Nine \u201ccombination-EUs\u201d were formed by grouping adjacent EUs, and bootstrapping was used to simulate the expected TAS results.<\/jats:p>\n<jats:p>When the combination-EUs were comprised of at least one \u201cpassing\u201d and one \u201cfailing\u201d EU, the majority of these combination-EU would pass the TAS 79% - 100% of the time. Even in the case when both component EUs had failed, the combination-EU was expected to \u201cpass\u201d 11% of the time.<\/jats:p>\n<jats:p>Simulations of mini-TAS, a strategy with smaller power and hence smaller sample size than TAS, resulted in more conservative \u201cpassing\u201d and \u201cfailing\u201d when implemented in original EUs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>Our results demonstrate the high potential for misclassification when the average prevalence of lymphatic filariasis in the combined areas differs with regards to the TAS threshold. Of particular concern is the risk of \u201cpassing\u201d larger EUs that include focal areas where prevalence is high enough to be potentially self-sustaining. Our results reaffirm the approach that Haiti took in forming smaller EUs. Where baseline or monitoring data show a high or heterogeneous prevalence, programs should leverage alternative strategies like mini-TAS in smaller EUs, or consider gathering additional data through spot check sites to advise EU formation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010150","type":"journal-article","created":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T18:37:27Z","timestamp":1643395047000},"page":"e0010150","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Simulating the effect of evaluation unit size on eligibility to stop mass drug administration for lymphatic filariasis in 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