Maximising the effect of combination HIV prevention in Kenya--Authors' reply.

1426 www.thelancet.com Vol 384 October 18, 2014 Authors’ reply We agree with Sally Blower and Brian Coburn that the aim of HIV prevention programmes is to reduce HIV incidence among men and women and that focusing resources on those locations with the greatest intensity of transmission can increase the eff ect of these programmes. When limited resources are allocated in a way that maximises their eff ect, three factors determine where the investments are made. First, is the epidemiological context, which was captured in our model through fitting to multiple indicators, including the sex ratio of HIV prevalence. The second determinant is what interventions are available, their efficacy, and their cost. Whereas men can directly benefit from low cost and highly eff ective circumcision interventions, there is unfortunately no such analogous intervention for women. A number of additional strategies that were not modelled, such as cash transfer to girls and interventions that can prevent intimate partner violence, are promising interventions for women, and could also be considered for inclusion in programmes. The fi nal factor is the budget. With the budget available, the greatest overall effect was not achieved by, for example, provision of all low risk women with pre-exposure prohylaxis (PrEP), but by focusing its use to sex workers in the highest Maximising the eff ect of combination HIV prevention in Kenya