Staedke SG, Gonahasa S, Dorsey G, et al. - In Uganda's national long-lasting insecticidal nets (LLINs) campaign, a pragmatic cluster-randomized trial was embedded with the aim to compare conventional LLINs with those containing piperonyl butoxide (PBO), a synergist that can partially restore pyrethroid susceptibility in mosquito vectors. Researchers performed random assignment of 104 health sub-districts, from 48 districts in Uganda, to LLINs with PBO (PermaNet 3.0 and Olyset Plus) and conventional LLINs (PermaNet 2.0 and Olyset Net). From March 25, 2017, to March 18, 2018, they randomly allocated 32 clusters to PermaNet 3.0, 20 to Olyset Plus, 37 to PermaNet 2.0, and 15 to Olyset Net. In the as-treated analysis, exclusion of three clusters was performed as no dominant LLIN was received, and reassignment of four clusters was performed, resulting in 49 PBO LLIN clusters (31 received PermaNet 3.0 and 18 received Olyset Plus) and 52 non-PBO LLIN clusters (39 received PermaNet 2.0 and 13 received Olyset Net). Cross-sectional surveys were conducted at baseline 6, 12, and 18 months after LLIN distribution in 50 randomly selected households per cluster (5,200 per survey); a subset of 10 households per cluster (1,040 per survey) were randomly selected for entomological surveys. Outcomes suggested more effective reduction of parasite prevalence in Uganda, where pyrethroid resistance is high, in correlation with using PBO LLINs vs conventional LLINs for up to 18 months. Evidence was thus gained in support of WHO's final recommendation on use of PBO LLINs.