UW Center for AIDS and STD

An Evaluation of STI Clinical and PrEP Services in Spokane County, Washington

The U.S. has experienced a significant increase in the number of reported sexually transmitted infections (STI) over the past decade. Untreated STIs can lead to further STI transmission, congenital infection, infertility, and the spread of HIV.

Spokane County, Washington is considered a high STI incidence jurisdiction, with high rates of STIs relative to both other Washington State and U.S. counties. Spokane County congenital syphilis rates in particular have been among some of the highest in Washington State in recent years, highlighting the need for investment in research and intervention development for sexual health promotion, including STI prevention services.

This report presents findings from a partnership between the Spokane Regional Health District (SRHD) and the University of Washington to identify opportunities to improve STI and HIV pre-exposure prophylaxis (PrEP) clinical services in Spokane County. Gaps and existing strengths in services were identified through local stakeholder interviews and ranked by subject matter experts (SMEs) in order of importance from highest priority to lowest priority. SMEs also voted on suitable and priority recommendations to address these gaps. We also include findings from three focus group discussions conducted by SRHD staff with local STI clinical services consumers.

Gaps identified by stakeholders and ranked by subject matter experts (SMEs):

  1. Inadequate availability of STI clinical services
  2. Inadequate accessibility of STI and PrEP services
  3. SRHD and local providers have limited capacity to provide STI services and PrEP
  4. Prenatal care is inadequate
  5. Marginalized and underserved populations experience significant stigma
  6. Providers sometimes lack training to adequately provide PrEP and STI services
  7. Socio-cultural context doesn’t prioritize STI and PrEP services
  8. Inadequate number of PrEP providers

Recommendations identified by SMEs:

  1. Fund a brick and mortar STI specialty clinic
  2. Work with large healthcare organizations to create coordinated system to promote sexual healthcare
  3. Lobby the state legislature regarding STI and PrEP services capacity
  4. Increase availability of walk in OB care
  5. Create an STI specialty clinic that specializes in care for underserved populations
  6. Fund a provider support network to encourage information sharing across county
  7. Create an STI specialty clinic with staff with expertise in working with marginalized patient populations
  8. Create training programs to encourage primary care providers to offer PrEP

You can read and download the full report here.