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. 2024 Jul 4;30(10):2813–2820. doi: 10.1038/s41591-024-03134-z

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — a, Definition of effects in incidence analyses. b, Definition of effects in prevalence analyses. c, Effects on incidence estimated with hierarchical TMLE. Direct-effects analysis includes recipients treated in target zones, spillover-effects analysis includes intervention non-recipients up to 1 km from an index case and total-effects analysis includes all individuals (intervention recipients and non-recipients) up to 1 km from an index case. The chemoprevention analyses compared rfMDA versus RACD; the vector-control analyses compared RAVC versus no RAVC; the combined-intervention analyses compared rfMDA and RAVC versus RACD only. All incidence outcome models were fit with cohort-level data, except for models of spillover effects of the combined intervention (chemoprevention and vector control n = 310 cohorts; combined intervention n = 143 cohorts, 38,048 individuals for spillover effects of the combined intervention). Models were adjusted for covariates that were screened separately for each model using a likelihood ratio test. The chemoprevention analysis included the period of 0–35 days following index-case detection for direct effects and 21–56 days for spillover effects. The vector control and combined-intervention analyses included the period of 0–6 months following index-case detection for direct effects and 17 days–6 months for spillover effects. Total-effects analyses include the person-time for the analyses of direct effects and spillover effects. The upper bound of the 95% CI for the combined-intervention direct effect was truncated from its original value of 381%. d, Effects on prevalence estimated with TMLE using individual-level data; standard errors were adjusted for clustering at the enumeration-area level. See n values for prevalence analyses in Supplementary Table 8, and for seroprevalence analyses in Supplementary Table 10. Models were unadjusted because there were fewer than 30 observations within the strata of the intervention and outcome. Direct-effects analysis includes individuals who resided within 500 m of any intervention recipients; spillover-effects analysis includes individuals with no intervention recipients within 500 m and any intervention recipients within 500 m–3 km; and total-effects analysis include individuals with any intervention recipients <3 km during the study. In c and d, data are presented as percentage effectiveness = (1 – RR) × 100%, in which RR is the incidence ratio or prevalence ratio between study arms. Vertical bars indicate 95% CIs, not accounting for potential outcome correlation.