A national, geographic database of CDC-funded HIV prevention services: development challenges and potential applications

Abstract

Background: From 2000-2002, the Centers for Disease Control and Prevention (CDC) funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs). Program managers at CDC recognized the potential of a geographic information system (GIS) to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1) geopolitical boundaries and 2) geographic distance.

Results: The survey response rate was 70.3%, i.e. 1,020 of 1,450 community-based organizations responded. The number of HIV prevention programs administered by each CBO ranged from 1 to 23. The survey provided information about 3,028 prevention programs, including descriptions of intervention types, risk populations, race and ethnicity, CBO location and geographic service area. We incorporated this information into a large GIS database, the HIV Prevention Services Database. The use of geopolitical boundaries provided more accurate results than geographic distance. The use of a reference map with the questionnaire improved completeness, accuracy and precision of service area data.

Conclusion: The survey instrument design and database development procedures that we used for this study successfully met our objective. The development of the HIV Prevention Services Database for CDC is an important step toward the implementation of a spatial decision support system. Due to the costs involved in a nationwide survey such as this, we recommend that future data collection efforts use Web-based survey methodologies that incorporate interactive maps.

Figure 1

CBO response to HIV prevention service area survey. This map shows the location of all CBOs that received CDC funding for HIV prevention services in 2000. CBOs that responded are shown in red; green triangles indicate a non-response.

Figure 2

Response rates by state. This map shows the CBO response rate, by state and/or territory. Darker shades indicate higher response rates. White indicates no response.

Figure 3

Database tables and their linkages. This diagram shows how the three main tables in the HIV Prevention Services Database were linked, or related. CBOs are linked to the GEOGAREA and PROGRAM tables by CBO-ID. The GEOGAREA table contains one record per geographic unit per CBO. This table contains the FIPS codes necessary for linkage to a GIS (map) database.

Figure 4

Query tool interface. This tool allows users to structure a query based on intervention type, race/ethnicity and risk population, then map corresponding CBO and program locations and/or geographic service areas.

Figure 5

HIV prevention services to Hispanics or Latinos. This map is the result of a query to the HIV Prevention Services Database. It shows all areas where HIV prevention services are provided to Hispanics/Latinos. Service areas are drawn in pink. Program locations are represented by red dots. Green triangles represent the locations of CBOs that did not respond to the survey.