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Targeted Indoor Residual Spraying (TIRS), a modification of traditional indoor residual spraying focused on\n                      <jats:italic>Ae. aegypti<\/jats:italic>\n                      resting sites, has demonstrated promising results, yet its indirect community-wide effects remain underexplored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/principal findings<\/jats:title>\n                    <jats:p>\n                      We conducted an entomological cluster-randomized controlled trial in Iquitos, Peru, to evaluate the direct and indirect entomological impacts of TIRS using pirimiphos-methyl. Thirty clusters were randomized to receive either TIRS (15 clusters, 898 structures) or standard Ministry of Health vector control activities (15 clusters, 1,018 structures).\n                      <jats:italic>Aedes aegypti<\/jats:italic>\n                      indoor densities were assessed in the 45 days pre-intervention and at four time points up to 255 days post-intervention using Prokopack aspiration. Generalized linear mixed models with a negative binomial link were used to estimate incidence rate ratios (IRRs) and calculate efficacy (1\u2013IRR) for houses that received TIRS (direct effect) and untreated houses in TIRS clusters (indirect effect). Direct efficacy reached a 96% decrease in\n                      <jats:italic>Ae. aegypti<\/jats:italic>\n                      captured in sprayed houses at 15 days post-spraying and remained significant (40%) at 255 days post-spraying. Indirect efficacy reached 69% at 15 days and declined to 7% by 255 days post-spraying. Despite only 57% household-level TIRS coverage, both direct and indirect impacts on\n                      <jats:italic>Ae. aegypti<\/jats:italic>\n                      were significant during early post-intervention surveys, and after 8 months in TIRS clusters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions\/significance<\/jats:title>\n                    <jats:p>\n                      TIRS provided substantial and sustained reductions in indoor\n                      <jats:italic>Ae. aegypti<\/jats:italic>\n                      density, including measurable indirect effects in untreated homes within intervention clusters. These findings demonstrate the entomological value of TIRS even at moderate coverage levels and highlight its potential for both preventive and reactive vector control programs and should be considered for implementation by Ministries of Health in dengue-endemic urban settings as well as by the U.S. military when deployed to tropical or subtropical locations.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014390","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:49:06Z","timestamp":1792604946000},"page":"e0014390","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct and indirect entomological efficacy of Targeted Indoor Residual Spraying against Aedes aegypti in Iquitos, Peru"],"prefix":"10.1371","volume":"20","author":[{"given":"Helvio","family":"Astete","sequence":"first","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH","place":["Bellavista, Peru"],"department":["Department of Entomology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gissella M.","family":"Vasquez","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH","place":["Bellavista, Peru"],"department":["Department of Entomology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"L\u00f3pez-Sifuentes","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH","place":["Bellavista, Peru"],"department":["Department of Entomology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyquer","family":"Zambrano","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH","place":["Bellavista, Peru"],"department":["Department of Entomology"]},{"name":"Culmen International","place":["Alexandria, Virginia, United States of 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