Cervical cancer screening in rural Bhutan with the care HPV test on self-collected samples: an ongoing cross-sectional, population-based study (REACH-Bhutan)
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Objectives: The Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25–65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The ‘REACH-Bhutan’ study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan. Design: Cross-sectional, population-based study of cervical cancer screening based on the care HPV test on self-collected samples. Setting: Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan. Participants: Overall, 3648 women aged 30–60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population. Interventions: Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using care HPV in Thimphu (the Bhutanese capital) referral laboratory. Main outcome measures: Screening participation by geographic area, centre, age and travelling time. Previous screening history and care HPV positivity by selected characteristics of the participants. Results: In April/May 2016, 2590 women (median age: 41) were enrolled. Study participation was 71% and significantly heterogeneous by BHU (range: 31%–96%). Participation decreased with increase in age (81% in women aged 30–39 years; 59% in ≥50 years) and travelling time (90% in women living <30 min from the BHU vs 62% among those >6 hours away). 50% of participants reported no previous screening, with the proportion of never-screened women varying significantly by BHU (range: 2%–72%). 265 women (10%; 95% CI 9% to 11%) were care HPV positive, with a significant variation by BHU (range: 5%–19%) and number of sexual partners (prevalence ratio for ≥3 vs 0–1, 1.55; 95% CI 1.05 to 2.27). Conclusions: Community-based cervical cancer screening by testing self-collected samples for human papillomavirus (HPV) can achieve high coverage in rural Bhutan. However, solutions to bring self-collection, HPV testing and precancer treatment closer to the remotest villages are needed.
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The acceptability of HPV self-sampling has been shown to be very good among participating women.
“The acceptability of HPV self-sampling has been shown to be very good among participating women, the sample can be collected in their own private environment without having to visit the clinic or hospital, and self-sampling can also help women in overcoming multiple barriers [9-11].”
From Performance of HPV Self-Sample Collected by a Novel Kit in Comparison with Clinician Collected Sample for Cervical Cancer Screening (2024) · cites this paper as [10]
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- Authors
- Baussano, I., Tshering, S., Choden, T., Lazzarato, F., Tenet, V., Plummer, M., Franceschi, S., Clifford, G. M., & Tshomo, U.
- Affiliations
- Centre international de recherche sur le cancer (FR)
- Department of Obstetrics & Gynaecology, Dewanthang Hospital, Samdrup Jongkhar, Bhutan
- Department of Pathology & Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Corresponding author
- Baussano, Iacopo
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-07
- Volume
- 7
- Issue
- 7
- Pages
- e016309
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5734451
- OpenAlex
- W2736532641
- Cited by
- 22
- References
- 2
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 3 · 2021: 4 · 2020: 2 · 2018: 3 · 2017: 2
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, HPV testing, screening uptake, sexual partners, community-based screening, primary health centers, screening coverage
- MeSH terms
- Adult, Bhutan, Uterine Cervical Neoplasms, Community Participation, Cross-Sectional Studies, Female, Humans, Mass Screening, Middle Aged, Regression Analysis, Rural Population, Specimen Handling, Vaginal Smears, Early Detection of Cancer, Papanicolaou Test
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