Sexually transmitted infections (STIs) have emerged as significant public health concerns, imposing a substantial burden on both individuals and the healthcare system of the country. Additionally, STIs may also result in major extensive psychological consequences that profoundly affect individuals with STIs. Despite the government’s implementation of different initiatives aimed at addressing STI-related challenges, these conditions are associated with shame and stigma which act as barriers to the effective utilisation of healthcare services. The purpose of the present study is to generate evidence on barriers and facilitators to service utilisation and management of STIs in India.

Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis.

The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.

Antimicrobial resistance is a growing global public health threat driven by interactions between human, animal and environmental factors. Rural settings in low- and middle-income countries may face increased risk due to unregulated antibiotic use, close human–animal interactions, and environmental contamination. This study explored community-level knowledge, attitudes and practices related to antibiotic use and resistance among caregivers of children in rural South India using a One Health perspective.

Qualitative study using focus group discussions and thematic analysis.

Four rural villages in Tirunelveli district, Tamil Nadu, India.

Seventy-seven primary caregivers of children aged 2–12 years from households with backyard animals, purposively selected from a rural cohort study.

Three themes emerged. First, human health practices included reliance on home remedies, reuse of prescriptions, self-medication and incomplete antibiotic courses alongside misconceptions about antibiotics. Second, environmental factors such as untreated water consumption, open defecation, poor drainage and improper waste disposal were perceived to increase infection risks. Third, animal-related pathways included close child–animal contact, antibiotic use in livestock and unsafe disposal of animal waste. Limited healthcare access and transport costs influenced treatment-seeking behaviour.

Interconnected caregiver practices, environmental conditions and animal husbandry behaviours create multiple pathways for antimicrobial resistance transmission. Integrated, community-based interventions addressing behaviour change, healthcare access and environmental management are essential to support antibiotic stewardship within a One Health framework.