Implementation and Validation of Location-Based Survey to Assess Geographic Network and Hotspots of Sex and Drug Use in Los Angeles County (Preprint)

BACKGROUND The Ending the HIV Epidemic initiative in the U.S. relies on identifying HIV hotspots where new cases cluster, to geographically position new resources, expertise and technology to stop transmission. Yet, interventions targeted to places with high HIV transmission and acquisition risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity. OBJECTIVE We describe the implementation and validation of a web-based activity space survey of HIV risk behaviors that collect the geographic information that maps reported risk hotspots where risk behaviors are common onto reported sexual network geography. METHODS The survey design team developed a series of geospatial questions that followed a three-level structure that becomes more geographically precise as participants move through the levels. This design promotes privacy and comfortability of participants who are providing location information for sensitive topics. The survey was validated through nine cognitive interviews and iteratively updated based on participant feedback until saturation of topics and technical issues was achieved. RESULTS Four themes were identified through the cognitive interviews: Functionality of Geospatial Questions, Representation and Accessibility, Privacy, and Length and Understanding of the Survey. The ease of use for the geospatial questions was critical because many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks were critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The length of the survey was also a concern when using geographic software unfamiliar to participants and the inclusion of features that simplify the survey process. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete the survey. The longstanding relationship between participants and the research team was key for comfortability to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive/validating language in the survey alleviated concerns related to privacy and representation. CONCLUSIONS This study illustrates promising results for the feasibility of using a web-based mapping survey to collect sensitive location information relevant for ending the HIV epidemic. Key considerations for implementing this type of survey include trust from participants and community partners or research teams to overcome concerns related to privacy and comfortability. Implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial component of the survey.