title: No effect of insecticide treated curtain deployment on aedes infestation in a cluster randomized trial in a setting of low dengue transmission in Guantanamo, Cuba.
abstract: The current study evaluated the effectiveness and cost-effectiveness of Insecticide Treated Curtain (ITC) deployment for reducing dengue vector infestation levels in the Cuban context with intensive routine control activities. A cluster randomized controlled trial took place in Guantanamo city, east Cuba. Twelve neighborhoods (about 500 households each) were selected among the ones with the highest Aedes infestation levels in the previous two years, and were randomly allocated to the intervention and control arms. Long lasting ITC (PermaNet) were distributed in the intervention clusters in March 2009. Routine control activities were continued in the whole study area. In both study arms, we monitored monthly pre- and post-intervention House Index (HI, number of houses with at least 1 container with Aedes immature stages/100 houses inspected), during 12 and 18 months respectively. We evaluated the effect of ITC deployment on HI by fitting a generalized linear regression model with a negative binomial link function to these data.
  
  
  RESULTS
  At distribution, the ITC coverage (% of households using ≥1 ITC) reached 98.4%, with a median of 3 ITC distributed/household. After 18 months, the coverage remained 97.4%. The local Aedes species was susceptible to deltamethrin (mosquito mortality rate of 99.7%) and the residual deltamethrin activity in the ITC was within acceptable levels (mosquito mortality rate of 73.1%) after one year of curtain use. Over the 18 month observation period after ITC distribution, the adjusted HI rate ratio, intervention versus control clusters, was 1.15 (95% CI 0.57 to 2.34). The annualized cost per household of ITC implementation was 3.8 USD, against 16.8 USD for all routine ACP activities.
  
  
  CONCLUSIONS
  Deployment of ITC in a setting with already intensive routine Aedes control actions does not lead to reductions in Aedes infestation levels.
authors: Department of Epidemiology, Institute of Tropical Medicine "Pedro Kourí", Habana, Cuba.
authors: Maria Eugenia
authors: ME
authors: Toledo
authors: Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Veerle
authors: V
authors: Vanlerberghe
authors: Provincial Center of Surveillance and Vector Control, Guantanamo, Cuba.
authors: Isora
authors: I
authors: Lambert
authors: Department of Epidemiology, Institute of Tropical Medicine "Pedro Kourí", Habana, Cuba.
authors: Domingo
authors: D
authors: Montada
authors: Department of Epidemiology, Institute of Tropical Medicine "Pedro Kourí", Habana, Cuba.
authors: Alberto
authors: A
authors: Baly
authors: Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium; Department of Public Health, Ghent University, Ghent, Belgium.
authors: Patrick
authors: P
authors: Van der Stuyft
mesh_terms: D000330:Aedes / Q000187:drug effects*; D000818:Animals; D001512:Bedding and Linens; D003462:Cuba / Q000453:epidemiology; D003715:Dengue / Q000517:prevention & control* / Q000635:transmission*; D007306:Insecticides / Q000494:pharmacology; D009032:Mosquito Control / Q000379:methods
chemical_list: D007306:Insecticides