Our API directory now includes 40 reviews APIs. The newest is the Open Game API. The most popular, in terms of mashups, is the Shopzilla API. We list 27 Shopzilla mashups. Below you?ll find some more stats from the directory, including the entire list of reviews APIs.
In terms of the technical details, REST and JSON lead the way. There are 31 reviews REST APIs and 2 reviews SOAP APIs. Our directory lists 25 reviews JSON APIs and 23 reviews XML APIs.
The most common tags within reviews are 13 recommendations reviews APIs, 12 social reviews APIs and 7 shopping reviews APIs.
On the mashup side, we list 60 reviews mashups. We named VitaminsMatch as mashup of the day in May.
For reference, here is a list of all 40 reviews APIs.
??Adegga API: Social Wine Discovery service
??Allogarage API: French car dealership reviews and recommendations
??Aviresto API: French restaurant guide
??Best Buy BBYOpen Reviews API: Shopping reviews service
??blippr API: Recommendations service
??CNET API: Shopping services
??Cogix Ratings API: Survey Creation Service
??coRank API: Distributed user reviews service
??DealerRater API: Automotive Dealer Review Service
??Disc Golf Course Review API: Disk Golf Course Review Service
??Filmaster API: Movie review and recommendation service
??Foodspotting API: Food review and sharing service
??gdgt API: Consumer electronics review site
??Get Satisfaction API: Distributed product support services
??Google Base API: Platform for structure and semi-structured data
??High Gear Media API: Automotive reviews and news
??iDreamBooks API: Book review application
??LemonStand API: Ecommerce Shop Creation Service
??LouderVoice API: Review and comments service
??Mombo API: Social movie review service
??New York Times Movie Reviews API: NY Times newspaper movie review archives
Chris Kippenberger has an impressive resume: he's helped make music videos for Ridley Scott Associates. He worked behind the scenes in the adult industry. He's built his own drones. So how exactly did he end up making some of the prettiest car videos online?
"You get a pretty clear understanding about how male traffic moves and converts," explains Kippenberger, talking about what he learned working on the tech side of the adult industry. "Pretty similar to car videos, just guys can watch those at work."
The Internet is filled with flashy car videos these days. It used to be that Top Gear (which can cost $1 million per episode) was the only game in town, but now anybody can get a GoPro and a Canon, post their videos online, and get some quality car porn online. Nobody makes as many beautiful, affordable, consistently interesting car videos as Kippenberger, and he has a career in some of the weirder parts of the film world to thank.
Before I go on, let me say that his work is unforgettable.
His drone?s eye view of the N?rburgring debuted in January 2012 and not only was it amazing how good the video looked, but how he was able to get his shots. Renting a helicopter for a day could cost $50,000. Kippenberger's drone started off as a $630 XAircraft X650V-4. He was getting an unthinkable view for such a reasonable budget.
He's also well known for "Kart Kids" from last Fall. One the one hand it's an adorable short about a nine-year-old racer Curtis explaining 'how grip works,' but on the other, it's just an awesomely shot film on karting itself. The drone work is outstanding.
And what's always surprising about Kippenberger's videos is how he gets access to some of the most interesting people the car world. How else would we know about Heidi Hetzer, the 75-year-old former race car driver who now plans on driving a 91-year-old car around the world?
For car enthusiasts, it was like watching a dream.
And he can really shoot. In the 911 video above, Chris directed the shots from inside the car, while driving. Over speaker phone he (below, right) called his partner Marcus Gelhard (below, left) who was stationed down the mountain with the drone's remote controls. That's just cool.
So how did Kippenberger build up to making these videos? He actually started as an industrial design student in San Francisco. He was making chairs, but in the late '90s he moved to LA and started working in film. Why'd he switch fields? "Film seemed more of a kick than standing around in sawdust all day long."
He started working in post production, but things got strange. "It's not weird," explains Kippenberger, "just a little murky, which at first is alluring but in the long run was not sustainable." One entire post team he worked with got hooked on heroin and got fired. "They had this sophisticated script ring and were hitting drug stores in the Valley with fake casts and shit, and this at one of the premier post joints in the city."
So he left post production and started working at Ridley Scott Associates where he wrote music video concepts. He then left for Germany to become executive producer at Vice Germany. After that he made his move to the adult industry. At Vice and in the adult industry was where he learned everything he knew about distributing videos online.
"I liked the adult industry for its technical side," Kippenberger told me. "They are the silent pioneers of everything payment, streaming, etc. They built it all. They really need more acknowledgement."
Kippenberger worked in video streaming, encoding, transcoding and payments solutions, which isn't exactly what you expect when someone says they worked in the adult industry. Kippenberger was more obsessed with the technology anyway. He looks up to German programmer Fabian Thylmann, the reclusive "King of Porn" (according to the Financial Times), who revolutionized how porn could be distributed over the Internet. Free video clips and the advertising on pay-for-view websites are thanks to his work.
So how did he switch from real porn to car porn? Kippenberger told me that after a certain point he "just liked cars more than dealing with off-shore entities and bankers all day." It wasn't that difficult a change even. "[The] people are same. Most of the adult guys I know are into cars, so it was always a big part of our lifestyle."
And that's when Kippenberger discovered drones.
The drone thing was really just my way out of the boredom of film and video production.
I have always hated people who work on a film set.
It's all based on people forcing you to believe you need something only they know how to use blah blah blah - bunch of film bullies.
It's easy to focus just on those drones when you watch Kippenberger's videos. The aerial footage is just so wild, but when I pressed Kippenberger about his drones, Chris told me, "the drone is a flying camera, not a good idea generator." If it was just about his equipment, "we'd just have to buy a GoPro, but that [alone] doesn't make good films."
Kippenberger explained more why drones are so useful to him in an interview with Co.Create on Fast Company.
?The drone turns the camera into a flying camera which can shoot indoors and get very close to your subject while inducing childlike joy when retrieving footage,? Kippenberger told Co.Create. ?Then there?s the cost thing?at the end of the day it is a tool that won?t make movies on its own, but (UAVs) help open the door to unseen perspectives. The challenge for us is getting clients away from depending on agencies gobbling up their budgets when there is little reason to employ a team of 60 people to shoot a 30-second spot (when you have a drone).?
What's important to Kippenberger is how he trims the fat out of his production process, and how he offers clients great content without "selling them shit they don't really need."
Every time I see a production blocking a street employing 200 makes me feel that this way of producing is outdated. It's not just the production it's the entire creative process and industry around it. Agency, production, post production and all the people in between who want to be fed.
I asked him how he's able to get by without a big team. He said, "I'm ruthless."
I'm ruthless. Not sure if its going to give me cancer...It's about creating good content by all means necessary. It's not necessarily a way to make friends, but you do get respect.
I like the direct response these days, drum up an idea go shoot it, post it, next. It's the democratization of film making.
So what are Kippenberger's plans for the future? Well, there's some tech Kippenberger and Marcus are working on.
We have a lab for quite some time [and] we are working around the clock to lighten production. Ideally sort of a skunk works - the M or AMG divison of film production.
Its a lot about the stabilization system in my opinion we go through changes on a day to day basis...For instance in the handheld system we are sourcing intellectual property we developed in gimbal for the drones which are now in the hand set...
Expanding application is paramount - we are currently looking at r&d for sticking them on rc hovercrafts capable of speeds of 80km/h traveling on land, water, and snow.
But there's more to it than just tech.
The last 10 films where an exercise. They where a test to see what could be done under extreme circumstances. Very little budget and time. I was able to put together a production unit which can execute high value images in a very small footprint - light weight and efficient.
The next goal is to find partners and add scale.
If you look across his whole career, you can see how Kippenberger would end up where he is now. He left the film industry when he thought he could do something leaner than the big budget productions in LA. Working in the adult industry taught him how to distribute his work and how to draw up online traffic. When he started making his own videos, he kept things lightweight, which brought him to drones.
Conveniently, all of these themes come together in Kippenberger's just-released video. He said he was trying to pare down his car videos to have the same minimalism he tries to keep with his company. It's called "Maximum Reduction." I should let the sound and the visuals speak for themselves, but if this video is anything to go by, his upcoming work is going to be as good as ever.
After weeks of clashes between protesters and police in Istanbul and around the country, Turkey?s Prime Minister Recep Tayyip Erdogan has seen a measurable drop in popularity, according to MetroPOLL Strategic and Social Research Center.
Though Mr. Erdogan still has the support of more than half of those polled, the numbers indicate that he is not immune from losing his majority if the unrest continues.
The center found that he has steadily lost popularity since last December, when he enjoyed a 62.3 percent approval rating. In April Erdogan's job approval dropped to 60.8 percent and in the most recent survey it fell to 53.5 percent. Meanwhile, Erdogan?s Justice and Development Party (AKP) has lost only one percentage point since last April and a number of opposition parties increased by 1 to 3 percent in popularity.
RECOMMENDED: Think you know Turkey? Take our country quiz.
Erdogan, whose party won 50 percent of the vote in the country?s last election in 2011, has used that sweeping victory as a mandate to push through a number of policies unpopular with the other half of the country who did not vote for him. The recent poll indicates he may have trouble advancing his agenda going forward.
?In my opinion this is a very big drop,? says Ozer Sencar, general director of MetroPOLL, explaining the prime minister?s loss in popularity. ?If the prime minister can?t understand this young generation, the opposition will increase, but if he understands these young people and creates solutions to these problems, he will manage the problem.?
Turks will next cast their ballots in 2014 local elections and again in general elections in 2015. Based on his findings, Mr. Sencar says Erdogan and the AKP may be surprised by the number of voters that shift to rival parties.
Protests in Turkey erupted nearly three weeks ago when police used excessive force to break up a peaceful sit-in to protect Istanbul?s Gezi Park from commercial development. The survey found that 62.9 percent of respondents would prefer to keep Gezi Park as it is, while just 23.3 percent favored the plan to develop it, and the remaining 13.8 percent had no response.
At the core of protesters? complaints is the behavior of the government, which demonstrators say has become more authoritarian than democratic. For the first time in its recent survey MetroPOLL asked if respondents shared this sentiment.
It found that 49.9 percent of those surveyed said they worried the government was becoming more authoritarian.
To conduct the poll, the center interviewed 2,818 people nationwide from June 3 to 13 with a 2 percent margin of error. Police broke up the sit-in at Gezi Park, triggering nationwide protests, on May 31.
Erdogan has downplayed protests, blaming everyone from the foreign media to twitter. On Sunday he told a crowd of hundreds or thousands of supporters that his ?patience has run out? with the demonstrations.
While the crowds Sunday made clear that he still has his plenty of support, he seems unlikely to come out of these protests unscathed.
?If Gezi Park protests and these clashes are ongoing, I think many people cannot support AKP party,? says Yusuf Cinar, president of Strategic Outlook, a Turkish think tank in Konya, Turkey. ?Turkey has a democracy and elections, so the government didn?t need to show their power, it was unnecessary in my opinion.?
Still there remains a strong possibility that even if Erdogan and his party suffer a substantial loss of support, he will be able to win reelection in 2015. When he was first elected in 2002, he came into office with just 34 percent of the vote, and those who?ve taken to the streets in protest remain fragmented and thus far unable to produce a unity candidate capable of effectively challenging Erdogan.
?There is no concrete platform that will embrace all of these people. It?s a matter of organization, it?s a matter of a single leadership, it?s a matter of unity of purpose. Apart from being against Tayyip Erdogan, I don?t think there is anything that binds them,? says Umit Cizre, the director of the Center for Modern Turkish Studies at Istanbul Sehir University. Still, adds that opposition groups have gained confidence in their ability to affect the political agenda. ?Something has changed in the air,? she says.
SEOUL, South Korea (AP) ? Asian markets opened mostly lower Wednesday as investors waited for an update on the U.S. economy from the Federal Reserve and for some clarity from the Fed about its future course.
The results of a two-day Fed policy meeting will likely ripple through stock markets once investors learn whether there will be changes in the U.S. central bank's strategy for shoring up the world's No. 1 economy. The meeting is set to wrap up on Wednesday in Washington.
Stocks in Hong Kong, Shanghai and Seoul went south. Hong Kong's Hang Seng index was down 1.2 percent to 20,970.42, while South Korea's KOSPI index shed 0.7 percent to 1,886.85. Shares fell in New Zealand, the Philippines, Singapore and Indonesia.
But Asia's heavyweight Japan's Nikkei stock average added 1.3 percent to 13,169.97 while Australia's S&P/ASX 200 index was up 0.8 percent to 4,852.50.
For weeks now, markets have been gripped with uncertainty over whether the Fed will start reducing its financial assets purchases. The Fed's super-easy monetary policy has helped drive sentiment in the markets. Any reduction ? so-called tapering ? could spook investors who have become accustomed to seeing much of the money generated by the policy ending up in financial markets.
The uncertainty was caused by comments made by Fed chairman Ben Bernanke in May and investors will be hoping for a clearer picture at the end of the meeting Wednesday. Though no change is expected, investors will be looking for a clearer line in the accompanying Fed statement and in Bernanke's post-meeting press conference.
"At best the markets will be looking for reassurance from Bernanke that the Fed intends to keep rates low for some time to come and that it will be looking to manage any form of reduction of stimulus measures in a very gradual and orderly manner in a fashion that takes into account the state of the US economy," said Michael Hewson, senior market analyst at CMC Markets.
On Tuesday, the FTSE 100 index of leading British shares ended 0.7 percent higher at 6,374, while Germany's DAX rose 0.2 percent to 8,229. The CAC-40 in France was barely changed, down 0.08 percent at 3,860.
On Wall Street, the Dow Jones industrial average rose 0.9 percent, to close at 15,318.23 on Tuesday. The Standard & Poor's 500 index rose 0.8 percent to 1,651.81. The Nasdaq composite index rose 0.9 percent to 3,482.18.
Tuesday's batch of U.S. data did little to add to the debate over the Fed's stance. The rise in inflation to 1.4 percent in the year to May from 1.1 percent in April was in line with predictions and largely due to base effects. Meanwhile, the 6.8 percent rise in housing starts during the month was a tad lower than anticipated.
Benchmark oil for July delivery fell 6 cents to $98.38 per barrel in electronic trading on the New York Mercantile Exchange. The contract rose 67 cents to close at $98.44 a barrel on the Nymex on Tuesday.
In currencies, the euro fell to $1.3389 from $.13405 late Tuesday in New York. The dollar rose slightly to 95.29 yen from 95.27 yen.
HELENA, Mont. (AP) ? A well-traveled cat named "Mata Hairi" will soon be reunited with her owner after spending nearly 10 months traveling thousands of miles with a hitchhiker who rescued her from the rain.
The feline adventure started in Portland, Ore., when the cat's owner, Ron Buss, let her out of the house on Sept. 1. The cat, white with patches of dark gray, usually left for no more than a couple of hours at a time, but this time she didn't return.
When Michael King, who has been homeless since 2003, spotted Mata Hairi, she was crouched under a table at a cafe, trying to stay out of the pouring rain.
"I see cats all the time," King said. "I don't pick up cats. I don't want a cat, especially a full-grown one.
And he definitely didn't want to haul around the needed food and bowls that would add 20 pounds to his pack.
"Something told me to grab her. I don't know," King told the Independent Record (http://bit.ly/17T7QRQ ).
He named the cat Tabor, for the cafe where he found her.
She traveled with King as he hitchhiked to California, back to Portland and out to Montana, where King's foster father lives.
People often stopped them and asked to take photos.
"She's a hit on the streets of Portland," King said. "Very rarely do you see a cat riding on the top of someone's backpack."
King and his foster father, Walter Ebert, recently took the cat to a veterinarian in Helena, where a scan found a microchip, and the vet was able to contact Buss.
Buss is planning a party marking Mata's return, and King agrees it's an occasion for celebration.
But it's going to be emotional for King, too.
"I didn't want a cat in the first place. I just thought I was saving someone's cat," King said. "And that's what I've done. Now I've grown attached to her.
"My pack will be 20 pounds lighter," he said, "but a big hole, a big hole."
___
Information from: Independent Record, http://www.helenair.com
LONDON (AP) ? British police are investigating newspaper photos that show art collector Charles Saatchi with his hands around the throat of his wife, celebrity chef Nigella Lawson.
The pictures drew widespread condemnation after they were published by the Sunday People tabloid. The paper said the images were taken during an argument at a London restaurant on June 9.
The London police force said Monday it had not received a criminal complaint about the incident, and "inquiries are in hand to establish the facts" in order to assess whether a formal investigation is warranted.
Lawson's spokesman, Mark Hutchinson, declined to comment on the images. But Saatchi, Britain's best-known art collector, told London's Evening Standard newspaper that the pictures misrepresented a "playful tiff."
Saatchi, an Evening Standard columnist, said "the pictures are horrific but give a far more drastic and violent impression of what took place."
"About a week ago, we were sitting outside a restaurant having an intense debate about the children, and I held Nigella's neck repeatedly while attempting to emphasize my point," he was quoted as saying. "There was no grip, it was a playful tiff."
The 70-year-old said the couple "had made up by the time we were home."
Saatchi said after the story broke Sunday, he had advised Lawson to leave the couple's London home with their children "until the dust settled."
Lawson's spokesman confirmed that she and her children had left the family home.
Saatchi and Lawson married in 2003 and live in London with Lawson's son and daughter from her marriage to journalist John Diamond, who died of cancer in 2001, and Saatchi's daughter from a previous marriage.
In Britain a complaint from the victim is not necessary to lay assault charges if there is enough evidence from witnesses.
Lawson, 53, gained fame with her 1998 best-seller "How To Eat" and is one of Britain's best-known cookbook writers, as well as the host of foodie TV shows including "Nigella Bites" and ABC's cooking program "The Taste."
Saatchi, co-founder of the Saatchi & Saatchi ad agency, owns one of London's biggest private art galleries. He was the main patron of the Young British Artists movement of the 1990s, which made household names of artists including Damien Hirst and Tracey Emin.
Cost-effective: Universal HIV testing in IndiaPublic release date: 10-Jun-2013 [ | E-mail | Share ]
Contact: David Orenstein david_orenstein@brown.edu 401-863-1862 Brown University
PROVIDENCE, R.I. [Brown University] In India most people who are HIV positive don't know it, yet testing and treatment are relatively cheap and available. It would therefore meet international standards of cost-effectiveness and save millions of lives for decades to test every person in the billion-plus population every five years according to a new study published in the journal PLoS One.
The findings are based on a careful analysis of India's HIV epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries. A team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard, and in Chennai, India, integrated scores of factors specific to the country to find that testing for the whole country, with greater frequency for high-risk groups and areas, would pay off despite India's huge population and even in cases where conditions are worse than the researchers assume.
"Testing even 800 million adults is a public health undertaking of a historic magnitude," said study co-lead author Dr. Kartik Venkatesh, a postdoctoral fellow at Brown University and Women & Infants Hospital. Jessica Becker of Yale University is other lead author of the study, which first appeared May 31. "But what we were able to show is that even if you increase the cost of HIV treatment and care pretty significantly and really decrease the number of individuals who would link to care, even under those dire circumstances, testing this frequently and this widely still was reasonable."
Co-author Dr. Soumya Swaminathan, director of the National Institute for Research in Tuberculosis in Chennai, India, said the projections of the model will help the country in its battle with the epidemic, one of the world's largest.
"The paper explores various strategies and suggests cost-effective options for HIV testing in India," Swaminathan said. "As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions."
Dollars per life-years saved
The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organization's standard for cost effectiveness is an expenditure that is less than three times the per capita GDP of a country. In India in 2010, per capita GDP was $1,300. A program is therefore cost-effective in India if the expense is less than $3,900 to save a year of someone's life.
Modern antiretroviral therapies can give HIV-positive people a normal lifespan, and in India, which has a thriving generic pharmaceutical sector, first-line therapy costs only $8.61 a month (second-line therapy for those whose viruses prove resistant is $55.12 a month). HIV tests, meanwhile, cost only $3.33.
After extensive research to determine the best possible data for the country, Venkatesh, Becker, and the team coded several other parameters into the model including what percentage of people would refuse the test (18 percent), how many patients who test positive would get care (50 percent), the prevalence of HIV in the population (0.29 percent), and many other factors such as the monthly risk of opportunistic infection in positive patients, hospitalization costs, the effectiveness rate of therapy, and the likelihood of positive patients transmitting the virus to others.
They ran the models not only for the general population but also for people in high-risk districts and high-risk groups (e.g., with a higher prevalence of the virus but with more frequent testing today).
As they ran the numbers to determine the costs and effects on patients of broader and more frequent testing, they compared the results to what would happen under the status quo, in which there is less-than-universal testing.
Here is what they found:
Testing the general population just once would be "very cost-effective" because it would cost $1,100 per year of life saved (YLS) in general and $800 per YLS among high-risk populations.
Testing the population every five years would be "cost-effective" with a price of $1,900 per YLS saved in general, and $1,300 per YLS among high-risk groups.
Testing annually would not be cost-effective for the general population ($4,000/YLS), but would be for high-risk people ($1,800/YLS).
The general trends of cost effectiveness remained even after "sensitivity" analyses in which the researchers entered different statistical assumptions in the model in case their assumptions were too optimistic. But to make testing the general population every five years no longer cost-effective, the researchers had to tell the model that only 20 percent of the general population would agree to testing and only 20 percent of positive patients would get care.
Addressing an epidemic
Venkatesh said the main benefit of national testing would simply be getting more people to learn they are positive and therefore to seek effective care before they have full-blown AIDS and a complication. A secondary benefit, however, would be to curb transmission of the virus, both because behavior can change and because therapy can reduce transmissibility.
"Universal testing can have a big impact in catching a large number of individuals who are infected and getting them to seek treatment and seek services earlier in the course of their disease," said Venkatesh, who traveled to India at least once a year for all eight of his years as an M.D. and Ph.D. student at Brown from 2005 to 2013. "The classic story in India has always been patients present to care, traditionally men, with TB, the most common opportunistic disease. Then they get an HIV test and are found to be infected. At that point they bring their female partner, who happens to be infected and sometimes it's too late and a child has also been infected.
"If we tested earlier we may be able to have an impact on this kind of cascade of familial infection," Venkatesh said.
Co-author Dr. Nagalingeswaran Kumarasamy, chief medical officer of the YRG Care Medical Center, a major non-governmental HIV clinic in Chennai, India, said he thought the study could have an important influence.
"With the background wave on test and treat, this article will be a useful scientific tool for the National AIDS Control Organization of India to plan the testing strategies nationwide," he said.
###
In addition to Venkatesh, Becker, Swaminathan, and Kumarasamy, other authors are Yoriko Nakamura, Dr. Kenneth Mayer, Elena Losina, Dr. Timonthy Flanigan, Dr. Rochelle Walensky, and Dr. Kenneth Freedberg.
The National Institute of Allergy and Infectious Disease provided support for the study with grant R01 AI058736.
[ | E-mail | Share ]
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Cost-effective: Universal HIV testing in IndiaPublic release date: 10-Jun-2013 [ | E-mail | Share ]
Contact: David Orenstein david_orenstein@brown.edu 401-863-1862 Brown University
PROVIDENCE, R.I. [Brown University] In India most people who are HIV positive don't know it, yet testing and treatment are relatively cheap and available. It would therefore meet international standards of cost-effectiveness and save millions of lives for decades to test every person in the billion-plus population every five years according to a new study published in the journal PLoS One.
The findings are based on a careful analysis of India's HIV epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries. A team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard, and in Chennai, India, integrated scores of factors specific to the country to find that testing for the whole country, with greater frequency for high-risk groups and areas, would pay off despite India's huge population and even in cases where conditions are worse than the researchers assume.
"Testing even 800 million adults is a public health undertaking of a historic magnitude," said study co-lead author Dr. Kartik Venkatesh, a postdoctoral fellow at Brown University and Women & Infants Hospital. Jessica Becker of Yale University is other lead author of the study, which first appeared May 31. "But what we were able to show is that even if you increase the cost of HIV treatment and care pretty significantly and really decrease the number of individuals who would link to care, even under those dire circumstances, testing this frequently and this widely still was reasonable."
Co-author Dr. Soumya Swaminathan, director of the National Institute for Research in Tuberculosis in Chennai, India, said the projections of the model will help the country in its battle with the epidemic, one of the world's largest.
"The paper explores various strategies and suggests cost-effective options for HIV testing in India," Swaminathan said. "As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions."
Dollars per life-years saved
The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organization's standard for cost effectiveness is an expenditure that is less than three times the per capita GDP of a country. In India in 2010, per capita GDP was $1,300. A program is therefore cost-effective in India if the expense is less than $3,900 to save a year of someone's life.
Modern antiretroviral therapies can give HIV-positive people a normal lifespan, and in India, which has a thriving generic pharmaceutical sector, first-line therapy costs only $8.61 a month (second-line therapy for those whose viruses prove resistant is $55.12 a month). HIV tests, meanwhile, cost only $3.33.
After extensive research to determine the best possible data for the country, Venkatesh, Becker, and the team coded several other parameters into the model including what percentage of people would refuse the test (18 percent), how many patients who test positive would get care (50 percent), the prevalence of HIV in the population (0.29 percent), and many other factors such as the monthly risk of opportunistic infection in positive patients, hospitalization costs, the effectiveness rate of therapy, and the likelihood of positive patients transmitting the virus to others.
They ran the models not only for the general population but also for people in high-risk districts and high-risk groups (e.g., with a higher prevalence of the virus but with more frequent testing today).
As they ran the numbers to determine the costs and effects on patients of broader and more frequent testing, they compared the results to what would happen under the status quo, in which there is less-than-universal testing.
Here is what they found:
Testing the general population just once would be "very cost-effective" because it would cost $1,100 per year of life saved (YLS) in general and $800 per YLS among high-risk populations.
Testing the population every five years would be "cost-effective" with a price of $1,900 per YLS saved in general, and $1,300 per YLS among high-risk groups.
Testing annually would not be cost-effective for the general population ($4,000/YLS), but would be for high-risk people ($1,800/YLS).
The general trends of cost effectiveness remained even after "sensitivity" analyses in which the researchers entered different statistical assumptions in the model in case their assumptions were too optimistic. But to make testing the general population every five years no longer cost-effective, the researchers had to tell the model that only 20 percent of the general population would agree to testing and only 20 percent of positive patients would get care.
Addressing an epidemic
Venkatesh said the main benefit of national testing would simply be getting more people to learn they are positive and therefore to seek effective care before they have full-blown AIDS and a complication. A secondary benefit, however, would be to curb transmission of the virus, both because behavior can change and because therapy can reduce transmissibility.
"Universal testing can have a big impact in catching a large number of individuals who are infected and getting them to seek treatment and seek services earlier in the course of their disease," said Venkatesh, who traveled to India at least once a year for all eight of his years as an M.D. and Ph.D. student at Brown from 2005 to 2013. "The classic story in India has always been patients present to care, traditionally men, with TB, the most common opportunistic disease. Then they get an HIV test and are found to be infected. At that point they bring their female partner, who happens to be infected and sometimes it's too late and a child has also been infected.
"If we tested earlier we may be able to have an impact on this kind of cascade of familial infection," Venkatesh said.
Co-author Dr. Nagalingeswaran Kumarasamy, chief medical officer of the YRG Care Medical Center, a major non-governmental HIV clinic in Chennai, India, said he thought the study could have an important influence.
"With the background wave on test and treat, this article will be a useful scientific tool for the National AIDS Control Organization of India to plan the testing strategies nationwide," he said.
###
In addition to Venkatesh, Becker, Swaminathan, and Kumarasamy, other authors are Yoriko Nakamura, Dr. Kenneth Mayer, Elena Losina, Dr. Timonthy Flanigan, Dr. Rochelle Walensky, and Dr. Kenneth Freedberg.
The National Institute of Allergy and Infectious Disease provided support for the study with grant R01 AI058736.
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Public release date: 10-Jun-2013
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