13 August 2025.The conditionality of this recommendation is largely driven by the current higher unit cost of pyrethroid-PBO ITNs compared to pyrethroid-only LLINs and therefore the uncertainty of their cost-effectiveness. Furthermore, as PBO is less wash-resistant than pyrethroids, its bioavailability declines faster over the three-year estimated life of an ITN; therefore, the added impact of pyrethroid-PBO ITNs over that of pyrethroid-only LLINs may decline over time. The evidence comes from two sites in eastern Africa with pyrethroid resistance and not from other geographies where