The Sequential Multiple Assignment Randomized Trial for Controlling Infectious Diseases: A Review of Recent Developments

Infectious diseases have posed severe threats to public health across the world. Effective prevention and control of infectious diseases in the long term requires adapting interventions based on epidemiological evidence. The sequential multiple assignment randomized trial (SMART) is a multistage randomized trial that can provide valid evidence of when and how to adapt interventions for controlling infectious diseases based on evolving epidemiological evidence. We review recent developments in SMARTs to bring wider attention to the potential benefits of employing SMARTs in constructing effective adaptive interventions for controlling infectious diseases and other threats to public health. We discuss 2 example SMARTs for infectious diseases and summarize recent developments in SMARTs from the varied aspects of design, analysis, cost, and ethics. Public health investigators are encouraged to familiarize themselves with the related materials we discuss and collaborate with experts in SMARTs to translate the methodological developments into preeminent public health research. (Am J Public Health. 2023;113(1):49–59. https://doi.org/10.2105/AJPH.2022.307135 )