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medRxiv PreprintsInternational5 November 2026

Estimation of fine-scale spatial heterogeneity in treatment effects in a large cluster-randomized trial

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Treatment effects in randomized trials may vary geographically, and estimating this variation is a broadly generalizable problem for large-scale, cluster-randomized trials. We conducted a secondary analysis of AVENIR, a cluster-randomized, placebo-controlled trial of biannual azithromycin distribution among children aged 1-59 months in Dosso, Niger (2020-2023). We assessed whether the survival benefit of mass azithromycin distribution varied geographically using Poisson models to estimate spatially continuous child mortality and average treatment effects (ATE). Among 1390 villages (276,452 per
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