1. Abstract

Introduction Sexually transmitted infections (STIs) represent a significant public health challenge globally, with the Southern Africa region experiencing particularly high rates. In Eswatini, the burden of STIs, including HIV, is alarming, necessitating effective prevention strategies. Pre-exposure prophylaxis (PrEP) has been introduced as a key intervention, yet its impact on condom use and STI prevalence remains underexplored.

Objective This study aims to evaluate and compare condom use patterns and the prevalence of STIs among clients using PrEP and those who do not, among clients attending an STI Wellness Clinic in Eswatini.

Methods A prospective cross-sectional quantitative study will be conducted from February to June 2026 at the LaMvelase STI Wellness Centre. Participants will include HIV-negative individuals aged 15 and above, recruited through purposive sampling. Data will be collected via structured questionnaires and medical records, assessing condom use frequency, sexual behaviour, and STI rates. Laboratory testing will be conducted to confirm STI diagnoses. Statistical analyses will include descriptive statistics and logistic regression to identify associations between PrEP use and STI prevalence.

Results This protocol describes a study designed to assess the relationship between PrEP use, condom use behaviour, and STI prevalence among clients attending a specialised STI clinic in Eswatini. Findings will inform public health strategies and educational programs aimed at reducing STI rates and improving sexual health outcomes in Eswatini.

Conclusion Understanding the dynamics between PrEP use and sexual health practices is crucial for optimising STI prevention strategies. This research will contribute valuable data to guide interventions and health policies and to design more effective intervention 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:

Ethical clearance was obtained from the Eswatini Health and Human Research Review Board (EHHRRB)

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

Data Availability

All the relevant data that will be generated or analysed during this study will be available upon request, and subject to ethical approval and confidentiality requirements. De-identified data may be shared for research and public health purposes in accordance with regulatory standards.

AcronymsAHFAIDS Healthcare FoundationARTAntiretroviral TherapyCDCCentres for Disease Control and PreventionCMISClient Management Information SystemCTChlamydia trachomatisEHHRRBEswatini Health and Human Research Review BoardEMRElectronic Medical RecordFDAFood and Drug AdministrationFTCEmtricitabineHIVHuman Immunodeficiency VirusMOHMinistry of HealthNAATsNucleic Acid Amplification TestsNGNeisseria gonorrhoeaNaHSARNational HIV Semi-Annual ReviewPEPPost-Exposure ProphylaxisPIPrincipal InvestigatorPOCTPoint of Care TestingPrEPPre-exposure ProphylaxisReHSARRegional HIV Semi-Annual ReviewRPRRapid Plasma ReaginSHIMSSwaziland HIV Incidence Measurement SurveySPSSStatistical Package for the Social SciencesSTISexually Transmitted InfectionSTATAStatistical Analysis SoftwareTDFTenofovir Disoproxil FumarateTVTrichomonas VaginalisVMMCVoluntary Medical Male CircumcisionWHOWorld Health Organization3TCLamivudine