Client Awareness of a Specialised STI Wellness Clinic in Eswatini: Contextualised marketing for a stigma-free client-centred STI clinic.

This proposed cross-sectional study at Eswatini's LaMvelase STI Wellness Centre aims to evaluate client awareness, preferences, and perceptions of marketing strategies to optimize demand creation and improve sexual health outcomes in a high-prevalence setting.

The Gist

The Big Picture: A "Menu" for Health

Imagine the AIDS Healthcare Foundation (AHF) in Eswatini has opened a very special, private restaurant called the "STI Wellness Clinic." This isn't just any restaurant; it serves a specific type of meal (treatment for sexually transmitted infections) that many people are too embarrassed to order because of social stigma.

The problem? Even though the kitchen is open, the food is free, and the chefs are friendly, not enough people know the restaurant exists, or they don't know how to find the menu.

This paper is not a report on how many people ate the food yet. Instead, it is a blueprint (a recipe for the future) for a study designed to figure out exactly how to get more people to walk through the door.

The Problem: The "Silent" Restaurant

In Eswatini, infections like STIs and HIV are very common. The clinic has tried many ways to tell people about their services:

• The "Flyer" approach: Putting up posters and handing out pamphlets.
• The "Word of Mouth" approach: Asking friends to tell friends (peer educators).
• The "Digital" approach: Using Facebook, WhatsApp, and TikTok.
• The "Community" approach: Going out into neighborhoods to talk to people.

However, the clinic managers are flying blind. They know some people are coming in, but they don't know which specific advertisement or conversation actually convinced them to show up. It's like a chef guessing which spice made the dish popular without ever asking the diners.

The Plan: The "Customer Survey"

The authors (a team of researchers from AHF, a Canadian university, and a medical college) are planning a study to act as a super-detailed customer survey.

Who are they asking?
They will stop every 5th person who walks into the clinic (a method called "systematic sampling") and ask them a series of questions. They will talk to anyone aged 15 and up, regardless of their HIV status.

What are they asking?
Think of this as a "Taste Test" for marketing:

1. The "How did you hear about us?" question: Did you see a billboard? Did a friend tell you? Did you see a TikTok video?
2. The "Trust" question: Which source do you believe the most?
3. The "Comfort" question: Did you feel safe coming here?
4. The "Preferences" question: If we want to tell you about a new service next time, should we text you, call you, or put a poster up?

The Timeline: A Future Project

It is important to note that this paper is a plan, not a finished story.

• The Study: It hasn't happened yet. The team is scheduled to start interviewing people in February 2026 and finish in June 2026.
• The Goal: They want to collect data from about 422 people to get a clear picture.
• The Output: Once they finish, they will write a report that tells the clinic exactly which marketing "spices" work best for different groups of people (like teenagers vs. adults, or different neighborhoods).

Why Do This? (The "Why")

The authors argue that if you spend money on marketing but don't know if it's working, you are wasting resources.

• The Analogy: Imagine you are trying to fill a swimming pool. You have a hose, a bucket, and a fire truck. If you don't know which tool fills the pool fastest, you might keep using the bucket when the fire truck would have done the job in seconds.
• The Specific Goal: They want to find the "fire truck" for Eswatini's STI clinic. They want to know which communication channel (radio, social media, or friends) is the most effective at breaking down the fear and stigma so people feel comfortable seeking help.

The Rules of the Game (Ethics)

Because this topic is very sensitive (people might be embarrassed or afraid of being judged), the researchers have strict rules:

• Privacy is King: All names will be hidden. The data will be locked away like a secret diary.
• No Parents Needed for Teens: Since the clinic deals with sensitive health issues, they have special permission to ask teenagers (15-17) for their own permission without needing a parent to sign. This is to ensure the teens feel safe and won't be scared off by a parent finding out.
• Voluntary: No one is forced to answer.

The Bottom Line

This paper is a proposal for a detective story. The researchers are setting up the tools to investigate how people in Eswatini find out about a life-saving clinic. Once the investigation is done (in mid-2026), they hope to hand the clinic a "User Manual" on how to talk to their community effectively, ensuring that the right message reaches the right people at the right time, ultimately helping to reduce the spread of infections.

Technical Summary

Technical Summary: Client Awareness of a Specialised STI Wellness Clinic in Eswatini

Problem Statement
Sexually transmitted infections (STIs) remain a critical public health challenge in Eswatini, characterized by high prevalence rates and a significant burden of co-infection with HIV. Despite the establishment of specialised STI Wellness Clinics by the AIDS Healthcare Foundation (AHF) Eswatini to provide integrated screening, treatment, and prevention services, service utilisation remains suboptimal. Current programmatic data indicates increases in clinic attendance following demand creation activities but fails to elucidate the specific mechanisms driving this uptake. There is a lack of empirical evidence regarding which marketing strategies effectively generate awareness, which communication channels are most trusted by clients, and how these factors influence health-seeking behavior. Furthermore, existing literature does not sufficiently address how clients perceive these interventions, particularly among key populations and adolescents who face barriers such as stigma, confidentiality concerns, and provider attitudes.

Methodology
This paper presents a study protocol for a cross-sectional analytical study scheduled to be conducted from February 2026 to June 2026 at the LaMvelase STI Wellness Centre in Manzini, Eswatini.

• Study Design and Setting: The study utilizes a cross-sectional design at a high-volume facility serving approximately 15,000 registered patients, including HIV-positive and HIV-negative individuals, with a focus on key populations and adolescents.
• Sampling: A systematic sampling approach will recruit every 5th client attending the clinic who is aged 15 years or older. The target sample size is 422 participants, calculated to ensure adequate power for subgroup analyses, adjusted for a 10% non-response rate.
• Data Collection: Data will be gathered via interviewer-administered structured questionnaires (available in English and Siswati) and extracted from medical records (CMIS and EMR). The survey covers demographic characteristics, sexual behavior, sources of awareness, exposure to marketing materials, preferred communication channels, and service satisfaction.
• Data Analysis: The analysis plan includes descriptive statistics to summarize awareness levels and communication preferences. Comparative analyses (Chi-square, T-tests, Mann-Whitney) will assess differences across demographic subgroups. Multivariable logistic regression will be employed to identify independent predictors of clinic awareness and service utilisation, adjusting for confounders such as age, gender, and key population status.
• Ethical Considerations: The study has received approval from the Eswatini Health and Human Research Review Board (EHHRRB). A waiver of parental consent is sought for participants aged 15–17 to protect confidentiality and encourage participation, in line with national guidelines on sexual and reproductive health services.

Key Contributions and Claims
As a protocol paper, this manuscript does not report empirical results but rather outlines the framework for generating evidence to address a critical gap in health communication strategy. The paper claims the following contributions:

1. Client-Centered Evidence: The study aims to shift from purely programmatic monitoring of utilisation trends to understanding the client-level drivers of awareness, recall, trust, and behavioral response to marketing messages.
2. Strategic Alignment: It seeks to evaluate the alignment between implemented demand creation strategies (e.g., community outreach, peer education, digital platforms) and actual client-reported awareness sources.
3. Optimization of Communication: By identifying the most effective and trusted communication channels for different demographic and key population groups, the study intends to inform evidence-based marketing strategies that reduce STI rates and improve sexual health outcomes.
4. Operational Recommendations: The research is designed to generate operational recommendations for improving the efficiency of demand creation investments and strengthening the linkage between community awareness and facility utilisation.

Significance
The paper posits that effective STI control in Eswatini depends not only on service availability but on the precision of demand generation and informed service utilisation. By systematically assessing client preferences and the perceived effectiveness of outreach, the study aims to guide public health strategies and educational programs. The findings are expected to support the design of more targeted, stigma-free, and client-centred interventions, ultimately contributing to the mitigation of STI and HIV impacts in the region. The study emphasizes that without understanding the "how" and "why" of client awareness, health programmes risk investing in inefficient or misaligned marketing strategies, particularly for services requiring high levels of confidentiality.