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Abstract Background “REACH‐Bhutan” aimed to evaluate the feasibility and clinical performance of a community‐based screening program for cervical cancer in rural Bhutan using self‐collected samples for high‐risk human papillomavirus (HR‐HPV) testing. Methods In April/May 2016, 2590 women aged 30–60 years were screened across rural Bhutan by providing a self‐collected sample for careHPV testing. All careHPV‐positive women, plus a random sample of careHPV‐negative women, were recalled for colposcopy and biopsy. Self‐samples also underwent GP5+/6+ polymerase chain reaction (PCR)‐based HR‐HPV DNA detection and genotyping. Cross‐sectional screening indices were estimated against histological high‐grade squamous intraepithelial lesions or worse (hHSIL+), including imputation of hHSIL+ in women without colposcopy. Results HR‐HPV positivity was 10.2% by careHPV and 14.8% by GP5+/6+ PCR. Twenty‐two cases of hHSIL+ were histologically diagnosed, including one invasive cancer; an additional 7 hHSIL+ were imputed in women without colposcopy. HR‐HPV testing by GP5+/6+ showed higher sensitivity for hHSIL+ (89.7%, 95% CI 72.6–97.8) than careHPV (75.9%, 95% CI 56.5–89.7). Negative predictive value was also slightly higher for GP5+/6+ (99.9%, 95% CI 99.6–100) than careHPV (99.7%, 95% CI 99.4–99.9). Specificity, however, was lower for GP5+/6+ (86.1%, 95% CI 84.6–87.4) than careHPV (90.6%, 95% CI 89.4–91.7), as was positive predictive value (6.9%, 95% CI 4.5–9.9 vs. 8.5%, 95% CI 5.4–12.6). Of 377 HR‐HPV‐positive women by GP5+/6+, 173 (45.9%) were careHPV‐positive, including 54.7% HPV16‐positive and 30.2% HPV18‐positive women. Conclusions The final REACH‐Bhutan results show that screening for cervical cancer with self‐collection of samples and HR‐HPV testing, in addition to our previous report of achieving high participation, can also perform well to detect women with hHSIL+.

Abstract Background The COVID-19 pandemic has reaffirmed an all-knowing truth—that health is central in the 2030 Sustainable Development Agenda. To fully control the infection in a community, accurate testing of suspected cases along with effective tracing and appropriate treatment (3Ts) is still crucial to slowing transmission of COVID-19 virus This study explored factors that influenced COVID-19 testing in Bhutan. The lessons learned from this study could serve as a roadmap to strengthen the current respond to COVID-19 and for future outbreaks, particularly in low- and middle-income countries. Methods The study employed an exploratory qualitative design. Data collection methods included interviews with key informants with a purposively selected sample of 20 participants. The interview findings were augmented by reviewing both published literature and unpublished documents.For the analysis of qualitative interviews, a hybrid approach of inductive and deductive coding and theme development was conducted to analyze findings. A tailored version of the WHO Health System Framework incorporating the Essential Public Health Function was used to guide data interpretation. Results Political will through the influence and leadership of the King of Bhutan played a crucial role in raising attention to the problem, and provision of adequate financial and technical relief to ensure that all people irrespective of their socioeconomic status do not pay to get tested of COVID-19. A compassionate leadership, Whole of Society approach is backed by the scientific community, functional health systems and community-based approaches, use of information technology for awareness creation and improved surveillance system, and fast-tracked COVID-19 testing service delivery. Conclusion Bhutan’s success relied greatly on multi-sectoral and systematic approach during policy design, implementation and monitoring, and active collaborative efforts involving consultation and engagements with a broad range of local (community members), national and global actors for accelerated COVID-19 testing. These efforts were made possible through improved health governance and leadership at all levels of the society.

IntroductionTransgender persons experience health disparities and are marginalized in many societies worldwide. Even their numbers are unknown in many countries. We conducted the first effort to estimate the population size of transgender women (TGW) and transgender men (TGM) in Bhutan from November 2019 to January 2020.MethodsCommunity-based surveys of TGW and TGM integrated several methods to estimate the size of hidden populations, including key informant mapping, wisdom-of-the-crowd, the service multiplier, and the unique object multiplier. Results of the several methods were synthesized using a Bayesian approach.ResultsSurveys included 34 TGW and 124 TGM. TGW was persons assigned to the male sex at birth and currently self-identified as "trans women" (91%), "women" (6%), or another gender (3%). TGM were persons assigned female sex at birth and self-identified as "trans men" (100%). Bayesian synthesis of the multiple methods estimated 84 TGW (credible interval 61-110) and 166 TGM (credible interval 124-211) in Bhutan.ConclusionsOur study documented that TGW and TGM are part of Bhutanese society, with TGW constituting 0.03% of adult women and TGM 0.06% of adult men. Estimates can help advocate for resources and programs to address the health and well-being of these communities.

Background: "REACH-Bhutan" aimed to evaluate the feasibility and clinical performance of a community-based screening program for cervical cancer in rural Bhutan using self-collected samples for high-risk human papillomavirus (HR-HPV) testing. Methods: In April/May 2016, 2590 women aged 30-60 years were screened across rural Bhutan by providing a self-collected sample for careHPV testing. All careHPV-positive women, plus a random sample of careHPV-negative women, were recalled for colposcopy and biopsy. Self-samples also underwent GP5+/6+ polymerase chain reaction (PCR)-based HR-HPV DNA detection and genotyping. Cross-sectional screening indices were estimated against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), including imputation of hHSIL+ in women without colposcopy. Results: HR-HPV positivity was 10.2% by careHPV and 14.8% by GP5+/6+ PCR. Twenty-two cases of hHSIL+ were histologically diagnosed, including one invasive cancer; an additional 7 hHSIL+ were imputed in women without colposcopy. HR-HPV testing by GP5+/6+ showed higher sensitivity for hHSIL+ (89.7%, 95% CI 72.6-97.8) than careHPV (75.9%, 95% CI 56.5-89.7). Negative predictive value was also slightly higher for GP5+/6+ (99.9%, 95% CI 99.6-100) than careHPV (99.7%, 95% CI 99.4-99.9). Specificity, however, was lower for GP5+/6+ (86.1%, 95% CI 84.6-87.4) than careHPV (90.6%, 95% CI 89.4-91.7), as was positive predictive value (6.9%, 95% CI 4.5-9.9 vs. 8.5%, 95% CI 5.4-12.6). Of 377 HR-HPV- positive women by GP5+/6+, 173 (45.9%) were careHPV-positive, including 54.7% HPV16-positive and 30.2% HPV18-positive women. Conclusions: The final REACH-Bhutan results show that screening for cervical cancer with self-collection of samples and HR-HPV testing, in addition to our previous report of achieving high participation, can also perform well to detect women with hHSIL+. [ABSTRACT FROM AUTHOR]