1. Abstract

Introduction Sexually transmitted infections (STIs) remain a major global public health challenge, with a particularly high burden in Southern Africa. In Eswatini, the burden of STIs, including HIV, is alarming, necessitating effective prevention strategies. Understanding clients’ engagement with STI services and how they learn about and access these services is vital for effective public health communication and service delivery. AHF Eswatini has implemented multiple demand creation strategies to improve awareness and utilisation of Wellness Clinic services, but evidence remains limited on which approaches are most effective from the client perspective.

Objective This study aims to assess clients’ awareness, preferences, and perceptions of marketing strategies used by the clinic to inform marketing, communication and engagement approaches. Specifically, the study will examine the main sources of awareness, preferred communication channels, perceived effectiveness of outreach activities, and the relationship between awareness and service utilisation. This manuscript reports the study protocol prior to initiation of participant recruitment and data collection.

Methods A cross-sectional analytical study will be conducted from February 2026 to June 2026 at the LaMvelase STI Wellness Centre. Participants will include clients attending the STI Wellness Centre regardless of HIV status. Individuals aged 15 and above will be recruited through systematic sampling after every 5th client interval. Data will be collected via structured questionnaires and medical records. Clients will be surveyed on how they learned about the clinic, service satisfaction, and preferred communication channels. Statistical analyses will include descriptive statistics, evaluation of marketing reach and effectiveness, and logistic regression to identify associations. The analysis will also compare awareness patterns across demographic and key population groups and explore alignment between client-reported awareness and the demand creation strategies implemented by AHF Eswatini.

Results This protocol describes a study designed to generate evidence on client awareness, communication preferences, and the effectiveness of marketing strategies for STI service utilisation. Findings will inform public health strategies and educational programs aimed at reducing STI rates and improving sexual health outcomes in Eswatini. The study is also expected to identify high-impact communication channels for different client groups and generate operational recommendations for improving demand creation efficiency.

Conclusion This research will contribute valuable data to guide interventions and health policies and to design more effective interventions and communication strategies in high STI prevalence settings, ultimately supporting efforts to mitigate the impact of STIs and HIV in Eswatini.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Approval for the study has been obtained from the Eswatini Health and Human Research Review Board (EHHRRB) under Protocol Reference Number EHHRRB206/2025.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

8. Data Availability Statement

Data generated or analysed during this study will be available from the corresponding author upon reasonable request.

AcronymsAHFAIDS Healthcare FoundationARTAntiretroviral TherapyCMISClient Management Information SystemCTChlamydia trachomatisEHHRRBEswatini Health and Human Research Review BoardEMRElectronic Medical RecordHIVHuman Immunodeficiency VirusMOHMinistry of HealthNGNeisseria gonorrhoeaNaHSARNational HIV Semi-Annual ReviewPEPPost-Exposure ProphylaxisPIPrincipal InvestigatorPrEPPre-Exposure ProphylaxisRPRRapid Plasma ReaginSHIMSSwaziland HIV Incidence Measurement SurveySPSSStatistical Package for the Social SciencesSTISexually Transmitted InfectionSTATAStatistical Analysis SoftwareVMMCVoluntary Medical Male CircumcisionWHOWorld Health Organization