The potential of attractive insecticide-treated nets (ITNs) in reducing malaria transmission: a modeling study

Introduction Recent studies suggest that insecticide-treated nets (ITNs) may actively attract malaria vectors, increasing their likelihood of coming into contact with the insecticide while potentially reducing personal protection. The impact of such attractive ITN on malaria transmission at the community level remains unclear. In this study, we developed a model to compare the effectiveness of attractive, inert and deterrent ITNs under varying levels of human usage and different degrees of physiological or behavioral resistance in malaria vectors. Methods We developed a model to simulate the host-seeking, feeding and mortality (HSFM) of mosquito vectors facing ITNs. This model allows mosquitoes to choose between two rooms based on the presence and remote influence (attractive, inert or deterrent) of ITNs. The HSFM model was then integrated into a malaria transmission model to compare the Plasmodium transmission potential (average number of infectious bites that a vector is expected to give during its lifetime) of mosquitoes exposed to these different type of ITNs under various scenarios of ITN coverage, physiological resistance (reduced ITN-induced mortality), quantitative resistance (increased indoor escape behaviors), and qualitative resistance (increased spatial-temporal avoidance of ITNs). Results The model predicts that attractive ITNs consistently reduce malaria transmission potential of vectors more effectively than inert or deterrent ITNs, even in the presence of resistant vector phenotypes. For instance, at intermediate use rate (50%), strongly attractive ITNs are expected to reduce transmission by up to 67% compared to deterrent ITNs. In resistant vector populations, attractive ITNs remained more effective overall, though the reduction in transmission were less pronounced. Conclusion Our findings suggest that both inert and attractive ITNs could enhance malaria control efforts, outperforming current deterrent ITNs, even in resistant vector populations. Shifting from deterrent to inert or attractive ITNs could significantly improve vector control strategies, warranting further research and product development to fully explore and optimize this approach. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at <https://doi.org/10.5281/zenodo.15121769> <https://doi.org/10.5281/zenodo.15121769>