Walmart's offering up to $300 off a new tablet when you trade in an older, working tablet. Meanwhile, Best Buy's giving at least $200 for working iPad 3, 4, or (old) mini models traded on a new one. [Walmart, Cnet]
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Video analytics startup Prism Skylabs announced today that it has raised $15 million in Series B funding.
The company launched at TechCrunch Disrupt in 2011 (co-founder Ron Palmeri is also co-founder of MkII Ventures and Layer, which took the top prize at the most recent Disrupt). It says it can use footage from existing security cameras to provide retailers and other businesses with “web-style analytics”.
For example, the company says it can provide graphics showing footpaths through the store, heat maps of customer interest, and customer counts and conversion. It supposedly works with more than 80 customers.
The new funding was led by Intel Capital, with participation from Presidio Ventures, Triangle Peak, Data Collective and Expa. Prism Skylabs last raised a $7.5 million Series A. (Past investors include CrunchFund, which, like TechCrunch, was founded by Michael Arrington.)
If you've been disappointed with some of the results that you've been achieving with your smartphone camera, there are ways to get great results. Compensate using apps -- and tricks within the apps. For example: Don't use free "come-on" apps available in Google's Play store without checking if their specifications restrict the resolution or quality. You get what you pay for.
Recently I wrote about some of the best ways to take, keep and share photographs with an Android smartphone. We looked at some physical aspects, like how to hold the phone, and how to zoom.
This week, we're looking at some of the tweaks you can make to squeeze out the best shots.
Step 1: Build an Arsenal of Apps
For an investment of a few dollars, you can up your game. I recommend Androidslide's paid Camera Zoom FX, available in the Google Play store, as a sharp, high-quality camera app with multiple manual settings comparable to those of a dedicated digital camera; Weavr's paid Vignette for its post-processing filters; and Spritefish's paid Fast Burst Camera for shooting kids and for sports.
Androidslide's Camera Zoom FX
Tip: In general, don't use free "come-on" apps available in Google's Play store without checking if their specifications restrict the resolution or quality. You get what you pay for with camera apps.
Look for a JPEG quality setting within any app you're using and ensure that it's set to 100 percent. This setting is related to compression of file size and dates back to the days of limited memory; more compression equates to a smaller file size.
Today's phones have enough memory that you don't have to worry about file size. A 100 percent quality setting means that there's no enforced compression that produces unclear images.
Find the Settings menu in your camera app and choose All Settings or similar. Then choose the Save settings and look for JPEG quality. Select 100 percent. Adjectives like Superfine are sometimes used to represent 100 percent quality.
Tip: Use the largest picture resolution setting available too. File size will be larger, but you'll be able to crop images later and retain overall document size.
Many camera apps, including Camera Zoom FX, allow you to adjust white balance. White balance is a form of compensation that is used to create natural colors.
Auto white balance is prone to error and is the reason you'll sometimes see a blue or purple tint in the picture on a gray day.
Change the white balance setting from Auto to Cloudy.
Find the Settings menu and look for a White Balance option.
Scene Mode is that set of options where you can choose Beach, Snow, Fireworks and so on. Beaches and snow are the two scenarios that best take advantage of these settings, and using them will compensate for a scene's brightness that underexposes the shot and creates a muted, subdued photograph.
Tilt Shift is an effect that you can use to correct for this. Look for it in the Lens Effects section of your app's Filter menu.
Finally, it's easy to forget that you've made a settings change that will alter the quality of images in a following session. For example, setting a Macro (short distance) focus to shoot images of plant life is going to mess up landscape (long distance) focus if you forget to reset it back.
If you're taking poor shots, check the settings.
Tip: Apps don't have a factory reset button like you'd get with a dedicated camera, so you need to go through each and every setting rather than performing a general settings reset. Look for Reset Effects buttons too.
Is there a piece of tech you'd like to know how to operate properly? Is there a gadget that's got you confounded? Please send your tech questions to me, and I'll try to answer as many as possible in this column.
And use the Talkback feature below to add your comments! 
WASHINGTON (AP) — Doctors may soon have two new drug options for patients with hepatitis C, just as the liver-destroying virus becomes a major public health concern for millions of baby boomers.
The Food and Drug Administration holds a public meeting this week to review two experimental medications from Johnson & Johnson and Gilead Sciences. The new drugs, if approved, could offer a quicker, more effective approach to eliminating hepatitis C, a blood-borne disease blamed for 15,000 deaths in the U.S. this year.
In a review posted online Tuesday, the FDA reported that J&J's drug simeprevir has a slightly higher cure rate than currently available treatments, though it also caused rashes and sunburn in some patients.
On Thursday the FDA will ask a panel of outside experts whether the drug should carry warnings about rashes and sunburn on its label. The agency is not required to follow the panel's advice, though it often does.
The meeting comes at a time when federal health officials are urging baby boomers to get tested for the virus, which can go unnoticed for decades before causing symptoms.
Between 3 million and 4 million Americans are infected with hepatitis C, and people born between 1945 and 1965 are five times more likely to have it than people of other age groups, according to the Centers for Disease Control and Prevention.
Many baby boomers contracted the virus by sharing needles or having sex with an infected person in their youth. The disease was also spread by blood transfusions before 1992, when blood banks began testing for the virus.
"If something is not done soon, all these people who were infected in the 60s and 70s are going to start experiencing the long-term consequences of liver disease," said Gaston Picchio, head of hepatitis drug development for J&J's Janssen Therapeutics unit.
Most people with hepatitis C do not even know they have the virus until after liver damage has occurred, causing abdominal pain, fatigue, itching and dark urine.
For most of the last 20 years, the standard treatment involved a grueling one-year regimen of pills and injections that caused flu-like symptoms and cured less than half of patients. Many patients failed to complete the full treatment cycle. Others delayed starting treatment at all in the hopes that more effective treatments would come along.
Two drugs approved in 2011 kicked off a new effort to treat the disease. Research shows that adding the two new drugs — Vertex Pharmaceuticals' Incivek and Merck & Co.'s Victrelis — to the older drug cocktail can boost cure rates to between 65 and 75 percent.
And the drugs the FDA is reviewing this week have the potential to push cure rates even higher.
J&J's simeprevir cured 80 percent of patients who had not previously been treated for the disease, according to the FDA's review. Additionally, the vast majority of patients were able to cut their treatment time in half to 24 weeks, compared with the usual 52 weeks. The New Brunswick, N.J., company is seeking approval to combine the daily pill with the older treatment regimen for patients with the most common form of the virus. J&J developed the drug with Swedish drugmaker Medivir.
On Friday, the same FDA panel will review another hepatitis C drug from Gilead Sciences Inc. that some analysts say will become the first-choice for treating the disease. The pill, known as sofosbuvir, has been shown to cure up to 90 percent of patients after just 12 weeks of therapy, according to one company study. Additionally, analysts believe the drug will eventually be used without interferon, the injectable medication used in the current drug cocktail that causes nausea, diarrhea and other unpleasant side effects.
Gilead is racing against other drugmakers to develop the first all-pill approach to treating hepatitis C, long viewed as the holy grail by drugmakers. Similar efforts are underway from Abbott Laboratories, Bristol-Myers Squibb Co., Vertex Pharmaceuticals and others.
Pharmaceutical industry consulting firm Decision Resources estimates the market for hepatitis C drugs will grow to more than $23 billion by 2018. Sales of the drugs are expected to decline to $17.5 billion by 2021 as more patients are cured of the virus.
FILE - This April 15, 1997 file photo shows an Air Force missile crew commander standing at the door of his launch capsule 100-feet under ground where he and his partner are responsible for 10 nuclear-armed ICBM's, in north-central Colorado. Twice this year alone, Air Force officers entrusted with the launch keys to nuclear-tipped missiles have been caught leaving open a blast door meant to help prevent a terrorist or other intruder from entering their underground command post and potentially compromising secret launch codes, Air Force officials told The Associated Press. The missiles stand in reinforced concrete silos and are linked to the control center by buried communications cables. The ICBMs are split evenly among “wings” based in North Dakota, Wyoming and Montana. Each wing is divided into three squadrons, each responsible for 50 missiles. (AP Photo/Eric Draper, File)
FILE - This April 15, 1997 file photo shows an Air Force missile crew commander standing at the door of his launch capsule 100-feet under ground where he and his partner are responsible for 10 nuclear-armed ICBM's, in north-central Colorado. Twice this year alone, Air Force officers entrusted with the launch keys to nuclear-tipped missiles have been caught leaving open a blast door meant to help prevent a terrorist or other intruder from entering their underground command post and potentially compromising secret launch codes, Air Force officials told The Associated Press. The missiles stand in reinforced concrete silos and are linked to the control center by buried communications cables. The ICBMs are split evenly among “wings” based in North Dakota, Wyoming and Montana. Each wing is divided into three squadrons, each responsible for 50 missiles. (AP Photo/Eric Draper, File)
This undated handout photo provided by the US Air Force shows Lt. Gen. James M. Kowalski, the commander of Air Force Global Strike Command, who is responsible for the entire force of 450 Minuteman 3 missiles, plus the Air Force’s nuclear-capable bombers. Twice this year alone, Air Force officers entrusted with the launch keys to nuclear-tipped missiles have been caught leaving open a blast door that is intended to help prevent a terrorist or other intruder from entering their underground command post and potentially compromising secret launch codes, Air Force officials told The Associated Press. (AP Photo/US Air Force)
WASHINGTON (AP) — Twice this year alone, Air Force officers entrusted with the launch keys to nuclear-tipped missiles have been caught leaving open a blast door that is intended to help prevent a terrorist or other intruder from entering their underground command post, Air Force officials have told The Associated Press.
The blast doors are never to be left open if one of the crew members inside is asleep — as was the case in both these instances — out of concern for the damage an intruder could cause, including the compromising of secret launch codes.
Transgressions such as this are rarely revealed publicly. But officials with direct knowledge of Air Force intercontinental ballistic missile operations told the AP that such violations have happened, undetected, many more times than in the cases of the two launch crew commanders and two deputy commanders who were given administrative punishments this year.
The blast door violations are another sign of serious trouble in the handling of the nation's nuclear arsenal. The AP has discovered a series of problems within the ICBM force, including a failed safety inspection, the temporary sidelining of launch officers deemed unfit for duty and the abrupt firing last week of the two-star general in charge. The problems, including low morale, underscore the challenges of keeping safe such a deadly force that is constantly on alert but is unlikely ever to be used.
The crews who operate the missiles are trained to follow rules without fail, including the prohibition against having the blast door open when only one crew member is awake, because the costs of a mistake are so high.
The officers, known as missileers, are custodians of keys that could launch nuclear hell. The warheads on the business ends of their missiles are capable of a nuclear yield many times that of the atomic bombs dropped on Japan in 1945.
"The only way that you can have a crew member be in 'rest status' is if that blast door is shut and there is no possibility of anyone accessing the launch control center," said Lt. Gen. James Kowalski, the commander of Air Force Global Strike Command. He is responsible for the entire force of 450 Minuteman 3 missiles, plus the Air Force's nuclear-capable bombers.
The written Air Force instruction on ICBM weapon safety, last updated in June 1996, says, "One crewmember at a time may sleep on duty, but both must be awake and capable of detecting an unauthorized act if ... the Launch Control Center blast door is open" or if someone other than the crew is present.
The blast door is not the first line of defense. An intruder intent on taking control of a missile command post would first face many layers of security before encountering the blast door, which — when closed — is secured by 12 hydraulically operated steel pins. The door is at the base of an elevator shaft. Entry to that elevator is controlled from an above-ground building. ICBM missile fields are monitored with security cameras and patrolled regularly by armed Air Force guards.
Each underground launch center, known as a capsule for its pill-like shape, monitors and operates 10 Minuteman 3 missiles.
The missiles stand in reinforced concrete silos and are linked to the control center by buried communications cables. The ICBMs are split evenly among "wings" based in North Dakota, Wyoming and Montana. Each wing is divided into three squadrons, each responsible for 50 missiles.
In neither of the two reported violations was security of the crews' missiles compromised, the Air Force said in response to questions from the AP, "due to the multiple safeguards and other protections in place." But these were clear-cut violations of what the Air Force calls "weapon system safety rules" meant to be strictly enforced in keeping with the potentially catastrophic, consequences of a breach of nuclear security.
In the two episodes confirmed by the Air Force, the multi-ton concrete-and-steel door that seals the entrance to the underground launch control center was deliberately left open while one of two crew members inside napped.
One officer lied about a violation but later admitted to it.
Sleep breaks are allowed during a 24-hour shift, known as an "alert." But a written rule says the door — meant to keep others out and to protect the crew from the blast effects of a direct nuclear strike — must be closed if one is napping.
In an extensive interview last week at his headquarters at Barksdale Air Force Base, La., Kowalski declined to say whether he was aware that ICBM launch crew members had violated the blast door rule on multiple occasions.
"I'm not aware of it being any different than it's ever been before," he said. "And if it had happened out there in the past and was tolerated, it is not tolerated now. So my sense of this is, if we know they're doing it they'll be disciplined for it."
It is clear that Air Force commanders do, in fact, know these violations are happening. One of the officers punished for a blast door violation in April at the 91st Missile Wing at Minot Air Force Base, N.D., admitted during questioning by superiors to having done it other times without getting caught.
Both officers involved in that case were given what the military calls non-judicial punishment under the Uniform Code of Military Justice, rather than court martialed. One was ordered to forfeit $2,246 in pay for two months and received a letter of reprimand, according to Lt. Col. John Sheets, spokesman for Air Force Global Strike Command. The other launch officer, who admitted to having committed the same violation "a few" times previously, was given a letter of admonishment, Sheets said.
Kowalski said the crews know better.
"This is not a training problem. This is some people out there are having a problem with discipline," he said.
The other confirmed blast door violation happened in May at Malmstrom Air Force Base, Mont. In that case a person who entered the capsule to do maintenance work realized that the deputy crew commander was asleep with the door open and reported the violation to superiors. Upon questioning, the deputy crew commander initially denied the accusation but later confessed and said her crew commander had encouraged her to lie, Sheets said.
The crew commander received a letter of reprimand and was ordered to forfeit $3,045 in pay for two months, Sheets said. The deputy crew commander was given a letter of reprimand. Punishment of that sort does not require the officer to leave the service but usually is a significant obstacle to promotion and could mean an early end to his or her career.
The AP was tipped off to the Malmstrom episode shortly after it happened by an official who felt strongly that it should be made public and that it reflected a more deeply rooted disciplinary problem inside the ICBM force. The AP learned of the Minot violation through an internal Air Force email. The AP confirmed both incidents with several other Air Force officials.
Sheets said the Minot and Malmstrom violations were the only blast door disciplinary cases in at least two years.
The willingness of some launch officers to leave the blast door open at times reflects a mindset far removed from the Cold War days when the U.S. lived in fear of a nuclear strike by the Soviet Union. It was that fear that provided the original rationale for placing ICBMs in reinforced underground silos and the launch control officers in buried capsules — so that in the event of an attack the officers might survive to launch a counterattack.
Today the fear of such an attack has all but disappeared and, with it, the appeal of strictly following the blast door rule.
Bruce Blair, who served as an ICBM launch control officer in the 1970s and is an advocate for phasing out the ICBM force, said violations should be taken seriously.
"This transgression might help enable outsiders to gain access to the launch center, and to its super-secret codes," Blair said. That would increase the risk of unauthorized launch or of compromising codes that might consequently have to be invalidated in order to prevent unauthorized launches, he said.
"Such invalidation might effectively neutralize for an extended period of time the entire U.S. strategic nuclear arsenal and the president's ability to launch strategic forces while the Pentagon scrambles to re-issue new codes," he added.
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Follow Robert Burns on Twitter at http://www.twitter.com/robertburnsAP
Associated PressSource: http://hosted2.ap.org/APDEFAULT/89ae8247abe8493fae24405546e9a1aa/Article_2013-10-22-US-Nuclear-Missteps/id-9528f31ea37a4015b02cbab8f93544e9White House press secretary Jay Carney introduces Council of Economic Advisers Chairman Jason Furman who spoke about the economy post government shutdown at the daily press briefing at the White House in Washington, Tuesday, Oct. 22, 2013. Furman said the addition of 148,000 jobs in September is a sign of "solid" growth but forecasts worsening in October because of the 16-day partial government shutdown. (AP Photo/Charles Dharapak)
White House press secretary Jay Carney introduces Council of Economic Advisers Chairman Jason Furman who spoke about the economy post government shutdown at the daily press briefing at the White House in Washington, Tuesday, Oct. 22, 2013. Furman said the addition of 148,000 jobs in September is a sign of "solid" growth but forecasts worsening in October because of the 16-day partial government shutdown. (AP Photo/Charles Dharapak)
President Barack Obama gestures while speaking in the Rose Garden of the White House in Washington, Monday, Oct. 21, 2013, on the initial rollout of the health care overhaul. Obama acknowledged that the widespread problems with his health care law's rollout are unacceptable, as the administration scrambles to fix the cascade of computer issues. (AP Photo/Charles Dharapak)
President Barack Obama, standing with supporters of his health care law, speaks in the Rose Garden of the White House in Washington, Monday, Oct. 21, 2013, on the initial rollout of the health care overhaul. Obama acknowledged that the widespread problems with his health care law's rollout are unacceptable, as the administration scrambles to fix the cascade of computer issues. (AP Photo/Charles Dharapak)
President Barack Obama gestures while speaking in the Rose Garden of the White House in Washington, Monday, Oct. 21, 2013, on the initial rollout of the health care overhaul. Obama acknowledged that the widespread problems with his health care law's rollout are unacceptable, as the administration scrambles to fix the cascade of computer issues. (AP Photo/ Evan Vucci)
WASHINGTON (AP) — Crammed into conference rooms with pizza for dinner, some programmers building the Obama administration's showcase health insurance website were growing increasingly stressed. Some worked past 10 p.m., energy drinks in hand. Others rewrote computer code over and over to meet what they considered last-minute requests for changes from the government or other contractors.
As questions mount over the website's failure, insider interviews and a review of technical specifications by The Associated Press found a mind-numbingly complex system put together by harried programmers who pushed out a final product that congressional investigators said was tested by the government and not private developers with more expertise.
Meanwhile, the White House said that President Barack Obama's longtime adviser Jeffrey Zients will provide management advice to help fix the system. White House press secretary Jay Carney says Zients will be on a short-term assignment at the Health and Human Services Department before he's due to take over as director of Obama's National Economic Council Jan. 1.
Carney cited Zients' expertise as a longtime management consultant and his "proven track record" since coming to the White House in 2009, both as interim budget director and as chief performance officer, when he headed an effort to streamline government and cut costs. "We're engaged in an all-out effort to improve the online experience," Carney said.
Health and Human Services Secretary Kathleen Sebelius said in a post on HealthCare.gov that her agency is also bringing in more experts and specialists from government and industry, including top Silicon Valley companies.
"This new infusion of talent will bring a powerful array of subject matter expertise and skills, including extensive experience scaling major IT systems," she said. "This effort is being marshaled as part of a cross-functional team that is working aggressively to diagnose parts of HealthCare.gov that are experiencing problems, learn from successful states, prioritize issues, and fix them."
Project developers for the health care website who spoke to the AP on condition of anonymity — because they feared they would otherwise be fired — said they raised doubts among themselves whether the website could be ready in time. They complained openly to each other about what they considered tight and unrealistic deadlines. One was nearly brought to tears over the stress of finishing on time, one developer said. Website builders saw red flags for months.
A review of internal architectural diagrams obtained by the AP revealed the system's complexity. Insurance applicants have a host of personal information verified, including income and immigration status. The system connects to other federal computer networks, including ones at the Social Security Administration, IRS, Veterans Administration, Office of Personnel Management and the Peace Corps.
Obama on Monday acknowledged technical problems that he described as "kinks in the system." But in remarks at a Rose Garden event, Obama offered no explanation for the failure except to note that high traffic to the website caused some of the slowdowns. He said it had been visited nearly 20 million times — fewer monthly visits so far than many commercial websites, such as PayPal, AOL, Wikipedia or Pinterest.
"The problem has been that the website that's supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody," Obama said. "There's no sugarcoating it. The website has been too slow. People have been getting stuck during the application process. And I think it's fair to say that nobody is more frustrated by that than I am."
The online system was envisioned as a simple way for people without health insurance to comparison-shop among competing plans offered in their state, pick their preferred level of coverage and cost and sign up. For many, it's not worked out that way so far.
Just weeks before the launch of HealthCare.gov on Oct. 1, one programmer said, colleagues huddled in conference rooms trying to patch "bugs," or deficiencies in computer code. Unresolved problems led to visitors experiencing cryptic error messages or enduring long waits trying to sign up.
Congressional investigators have concluded that the government's Centers for Medicare and Medicaid Services, not private software developers, tested the exchange's computer systems during the final weeks. That task, known as integration testing, is usually handled by software companies because it ferrets out problems before the public sees the final product.
The government spent at least $394 million in contracts to build the federal health care exchange and the data hub. Those contracts included major awards to Virginia-based CGI Federal Inc., Maryland-based Quality Software Services Inc. and Booz Allen Hamilton Inc.
CGI Federal said in a statement Monday it was working with the government and other contractors "around the clock" to improve the system, which it called "complex, ambitious and unprecedented."
The schematics from late 2012 show how officials designated a "data services hub" — a traffic cop for managing information — in lieu of a design that would have allowed state exchanges to connect directly to government servers when verifying an applicant's information. On Sunday, the Health and Human Services Department said the data hub was working but not meeting public expectations: "We are committed to doing better."
Administration officials so far have refused to say how many people actually have managed to enroll in insurance during the three weeks since the new marketplaces became available. Without enrollment numbers, it's impossible to know whether the program is on track to reach projections from the Congressional Budget Office that 7 million people would gain coverage during the first year the exchanges were available.
Instead, officials have selectively cited figures that put the insurance exchanges in a positive light. They say more than 19 million people have logged on to the federal website and nearly 500,000 have filled out applications for insurance through both the federal and state-run sites.
The flood of computer problems since the website went online has been deeply embarrassing for the White House. The snags have called into question whether the administration is capable of implementing the complex policy and why senior administration officials — including the president — appear to have been unaware of the scope of the problems when the exchange sites opened.
Even as the president spoke at the Rose Garden, more problems were coming to light. The administration acknowledged that a planned upgrade to the website had been postponed indefinitely and that online Spanish-language signups would remain unavailable, despite a promise to Hispanic groups that the capability would start this week. And the government tweaked the website's home page so visitors can now view phone numbers to apply the old-fashioned way or window-shop for insurance rates without registering first.
The House Energy and Commerce Committee was expected to conduct an oversight hearing Thursday, probably without Sebelius testifying. She could testify on Capitol Hill on the subject as early as next week.
Uninsured Americans have until about mid-February to sign up for coverage if they are to meet the law's requirement that they be insured by the end of March. If they don't, they will face a penalty. The administration says it's working to address the timing issue to provide more flexibility.
Sen. Marco Rubio, R-Fla., plans to introduce legislation to delay that requirement because: "It's not fair to punish people for not buying something that's not available," Rubio told "CBS This Morning" on Tuesday.
Citing the website problems, Sen. Jeanne Shaheen, D-N.H., also urged the White House to extend the open enrollment period past March 31, 2014.
In a letter Tuesday to Obama, Shaheen suggested extending open enrollment to "provide greater flexibility for the American people seeking to access health insurance," according to an emailed statement from her office. Shaheen also asked the White House to clarify how the "individual responsibility penalty will be administered and enforced" in light of the website's difficulties.
On Monday, the White House advised people frustrated by the online tangle that they can enroll by calling 1-800-318-2596 in a process that should take 25 minutes for an individual or 45 minutes for a family. Assistance is also available in communities from helpers who can be found at LocalHelp.HealthCare.gov.
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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
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Follow Jack Gillum on Twitter at http://twitter.com/jackgillum or Julie Pace at http://twitter.com/jpaceDC.
Associated PressSource: http://hosted2.ap.org/APDEFAULT/3d281c11a96b4ad082fe88aa0db04305/Article_2013-10-22-Obama-Health%20Care/id-9ef03f2182df46a4a651ac509171b02b![[ Back to EurekAlert! ]](http://www.eurekalert.org/images/back2e.gif){kind=small}
PUBLIC RELEASE DATE: 22-Oct-2013
ShareContact: Stephanie Berger
sb2247@columbia.edu
212-305-4372
Columbia University's Mailman School of Public Health
Brief risk-reduction counseling at the time of a rapid human immunodeficiency virus (HIV) test was not effective for reducing new sexually transmitted infections (STIs) during the subsequent 6 months among persons at risk for HIV. Findings from the latest research study are online in the October 23rd issue of JAMA.
Columbia Mailman School researcher Lisa R. Metsch, PhD, and colleagues conducted a trial to assess the effectiveness of counseling in reducing STI incidence. Participants were from nine STI clinics affiliated with the NIDA Drug Abuse Treatment Clinical Trials Network in Columbia, S.C.; Jacksonville, Fla.; Los Angeles; Miami; San Francisco; Pittsburgh; Portland, Ore.; Seattle and Washington, DC.
From April to December 2010, Project AWARE randomized 5,012 patients from the 9 STI clinics to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both the beginning of the study and 6-month follow-up. The core elements of the counseling that the patients received included a focus on the patient's specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps.
The pre-specified outcome was a cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis.
The researchers found no difference in 6-month composite STI incidence by study group: STI incidence was 250 of 2,039 (12.3 percent) in the counseling group and 226 of 2,032 (11.1 percent) in the information group. This pattern was consistent at all sites. Analyses by age group, race/ethnicity, and sex (for heterosexuals) also demonstrated no effect of counseling on STI rates.
In the U.S., approximately 1.1 million people are estimated to be living with HIV infection. The incidence of HIV infection is considered to have remained steady over the last decade, with about 50,000 new infections occurring annually. About l in 5 people living with HIV is thought to be undiagnosed. The U.S. Preventive Services Task Force recently recommended that all persons age 15 to 65 years be screened for HIV, according to background information in the article. A major issue regarding HIV testing of such a large population is the effectiveness of HIV risk-reduction counseling at the time of testing, because counseling involves considerable time, personnel, and financial costs.
"Despite the historical emphasis on risk-reduction counseling as integral to the HIV testing process, no contemporary data exist on the effectiveness of such counseling. The results of Project AWARE help fill this gap," said Dr. Metsch, who is the Stephen Smith Professor and Chair of the Department of Sociomedical Sciences at the Mailman School of Public Health.
"Overall, these study findings lend support for reconsidering the role of counseling as an essential adjunct to HIV testing. This inference is further buttressed by the additional costs associated with counseling at the time of testing: without evidence of effectiveness, counseling cannot be considered an efficient use of resources," noted Dr. Metsch. "Posttest counseling for persons testing HIV-positive remains essential, both for addressing psychological needs and for providing and ensuring follow-through with medical care and support. A more focused approach to providing information at the time of testing may allow clinics to use resources more efficiently to conduct universal testing, potentially detecting more HIV cases earlier and linking and engaging HIV-infected people in care."
###
The study was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health with a $12.3.million grant awarded through the American Recovery and Reinvestment Act.
Columbia University co-authors are Lauren Gooden, PhD and Paco Castellon, MPH in the Department of Sociomedical Sciences at the Mailman School of Public Health; and Susan Tross, PhD in Columbia's Department of Psychiatry and the New York Psychiatric Institute.
About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu
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PUBLIC RELEASE DATE: 22-Oct-2013
ShareContact: Stephanie Berger
sb2247@columbia.edu
212-305-4372
Columbia University's Mailman School of Public Health
Brief risk-reduction counseling at the time of a rapid human immunodeficiency virus (HIV) test was not effective for reducing new sexually transmitted infections (STIs) during the subsequent 6 months among persons at risk for HIV. Findings from the latest research study are online in the October 23rd issue of JAMA.
Columbia Mailman School researcher Lisa R. Metsch, PhD, and colleagues conducted a trial to assess the effectiveness of counseling in reducing STI incidence. Participants were from nine STI clinics affiliated with the NIDA Drug Abuse Treatment Clinical Trials Network in Columbia, S.C.; Jacksonville, Fla.; Los Angeles; Miami; San Francisco; Pittsburgh; Portland, Ore.; Seattle and Washington, DC.
From April to December 2010, Project AWARE randomized 5,012 patients from the 9 STI clinics to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both the beginning of the study and 6-month follow-up. The core elements of the counseling that the patients received included a focus on the patient's specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps.
The pre-specified outcome was a cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis.
The researchers found no difference in 6-month composite STI incidence by study group: STI incidence was 250 of 2,039 (12.3 percent) in the counseling group and 226 of 2,032 (11.1 percent) in the information group. This pattern was consistent at all sites. Analyses by age group, race/ethnicity, and sex (for heterosexuals) also demonstrated no effect of counseling on STI rates.
In the U.S., approximately 1.1 million people are estimated to be living with HIV infection. The incidence of HIV infection is considered to have remained steady over the last decade, with about 50,000 new infections occurring annually. About l in 5 people living with HIV is thought to be undiagnosed. The U.S. Preventive Services Task Force recently recommended that all persons age 15 to 65 years be screened for HIV, according to background information in the article. A major issue regarding HIV testing of such a large population is the effectiveness of HIV risk-reduction counseling at the time of testing, because counseling involves considerable time, personnel, and financial costs.
"Despite the historical emphasis on risk-reduction counseling as integral to the HIV testing process, no contemporary data exist on the effectiveness of such counseling. The results of Project AWARE help fill this gap," said Dr. Metsch, who is the Stephen Smith Professor and Chair of the Department of Sociomedical Sciences at the Mailman School of Public Health.
"Overall, these study findings lend support for reconsidering the role of counseling as an essential adjunct to HIV testing. This inference is further buttressed by the additional costs associated with counseling at the time of testing: without evidence of effectiveness, counseling cannot be considered an efficient use of resources," noted Dr. Metsch. "Posttest counseling for persons testing HIV-positive remains essential, both for addressing psychological needs and for providing and ensuring follow-through with medical care and support. A more focused approach to providing information at the time of testing may allow clinics to use resources more efficiently to conduct universal testing, potentially detecting more HIV cases earlier and linking and engaging HIV-infected people in care."
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The study was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health with a $12.3.million grant awarded through the American Recovery and Reinvestment Act.
Columbia University co-authors are Lauren Gooden, PhD and Paco Castellon, MPH in the Department of Sociomedical Sciences at the Mailman School of Public Health; and Susan Tross, PhD in Columbia's Department of Psychiatry and the New York Psychiatric Institute.
About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu
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