UW Center for AIDS and STD

An Evaluation of STI, HIV, and PrEP Services in Yakima County, Washington

At a national level in the United States, rates of reportable sexually transmitted infections (STIs) have markedly increased over the past five years. Undiagnosed and untreated STI infections can lead to ongoing transmission, congenital infections, increased risk of human immunodeficiency virus (HIV) acquisition, and infertility, among other preventable outcomes. As such, it is important to evaluate the availability and accessibility of STI, HIV, and pre-exposure prophylaxis (PrEP) services, identify gaps in services, and develop potential solutions well-tailored to the unique strengths and challenges of a given jurisdiction. These activities may be particularly important for informing funding priorities in high incidence areas.

Yakima County, located in south-central Washington State, has high rates of STIs relative to both other Washington State and U.S. counties. In 2022, the incidence of primary and secondary syphilis in Yakima County was more than threefold that of Washington State overall (90.4 vs. 24.4 per 100,000); this was the highest rate among all Washington State counties, highlighting the need for investment in local STI prevention and treatment services.

This report presents findings from a partnership between the Yakima Health District (YHD) and the University of Washington (UW) to identify context-specific STI, HIV &
PrEP clinical service gaps and potential remedial actions in Yakima County. We identified existing strengths and gaps in services through local stakeholder in-depth interviews and findings were shared with subject matter experts (SMEs). The SMEs ranked the gaps from highest priority to lowest priority. SMEs also voted on appropriate and feasible recommendations to address the identified gaps.

Gaps identified by stakeholders and ranked from highest to lowest priority:

  1. Geographic Concentration of STI Services
  2. Limited Walk-in STI Testing Availability
  3. Insufficient Access for Tribal Communities
  4. Insufficient Access for Communities Experiencing Unstable Housing for Substance Use
  5. Insufficient Access for Migrant Farmworkers
  6. Limited Provider Awareness of Existing Services
  7. Insufficient Community Outreach & Education
  8. Insufficient Prenatal Care for Underserved Communities
  9. Insufficient PrEP Providers
  10. Insufficient Infectious Disease Specialists

Recommendations identified:

  1. Increasing service availability in the Lower Valley region of Yakima County
  2. Expanding mobile STI services to more locations, with a particular aim to reach underserved populations
  3. Increasing partnerships between YHD and existing STI service providers to facilitate referrals, provider and nursing staff trainings, increased STI service accessibility, and reach of underserved populations
  4. Expanding hours and scope of services at the YHD Sexual Health Clinic
  5. Training existing providers in Yakima County in PrEP, rapid start ART, uncomplicated HIV treatment, and Hepatitis C treatment
  6. Advocating for a change in syphilis presumptive guidelines to make it easier for providers to treat suspected syphilis cases

You can read and download the full report here, and the Qualitative Data Supplement here.