{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:19:40Z","timestamp":1767831580983,"version":"3.49.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1053353"],"award-info":[{"award-number":["OPP1053353"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>\u201cREACH\u2010Bhutan\u201d aimed to evaluate the feasibility and clinical performance of a community\u2010based screening program for cervical cancer in rural Bhutan using self\u2010collected samples for high\u2010risk human papillomavirus (HR\u2010HPV) testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In April\/May 2016, 2590 women aged 30\u201360\u2009years were screened across rural Bhutan by providing a self\u2010collected sample for <jats:italic>care<\/jats:italic>HPV testing. All <jats:italic>care<\/jats:italic>HPV\u2010positive women, plus a random sample of <jats:italic>care<\/jats:italic>HPV\u2010negative women, were recalled for colposcopy and biopsy. Self\u2010samples also underwent GP5+\/6+ polymerase chain reaction (PCR)\u2010based HR\u2010HPV DNA detection and genotyping. Cross\u2010sectional screening indices were estimated against histological high\u2010grade squamous intraepithelial lesions or worse (hHSIL+), including imputation of hHSIL+ in women without colposcopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>HR\u2010HPV positivity was 10.2% by <jats:italic>care<\/jats:italic>HPV and 14.8% by GP5+\/6+ PCR. Twenty\u2010two cases of hHSIL+ were histologically diagnosed, including one invasive cancer; an additional 7 hHSIL+ were imputed in women without colposcopy. HR\u2010HPV testing by GP5+\/6+ showed higher sensitivity for hHSIL+ (89.7%, 95% CI 72.6\u201397.8) than <jats:italic>care<\/jats:italic>HPV (75.9%, 95% CI 56.5\u201389.7). Negative predictive value was also slightly higher for GP5+\/6+ (99.9%, 95% CI 99.6\u2013100) than <jats:italic>care<\/jats:italic>HPV (99.7%, 95% CI 99.4\u201399.9). Specificity, however, was lower for GP5+\/6+ (86.1%, 95% CI 84.6\u201387.4) than <jats:italic>care<\/jats:italic>HPV (90.6%, 95% CI 89.4\u201391.7), as was positive predictive value (6.9%, 95% CI 4.5\u20139.9 vs. 8.5%, 95% CI 5.4\u201312.6). Of 377 HR\u2010HPV\u2010positive women by GP5+\/6+, 173 (45.9%) were <jats:italic>care<\/jats:italic>HPV\u2010positive, including 54.7% HPV16\u2010positive and 30.2% HPV18\u2010positive women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The final REACH\u2010Bhutan results show that screening for cervical cancer with self\u2010collection of samples and HR\u2010HPV testing, in addition to our previous report of achieving high participation, can also perform well to detect women with hHSIL+.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5851","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T11:58:43Z","timestamp":1680263923000},"page":"11828-11837","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Human papillomavirus testing on self\u2010collected samples to detect high\u2010grade cervical lesions in rural Bhutan: The <scp>REACH\u2010Bhutan<\/scp> study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7534-333X","authenticated-orcid":false,"given":"Gary M.","family":"Clifford","sequence":"first","affiliation":[{"name":"Early Detection, Prevention and Infections Branch International Agency for Research on Cancer (IARC\/WHO)  Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iacopo","family":"Baussano","sequence":"additional","affiliation":[{"name":"Early Detection, Prevention and Infections Branch International Agency for Research on Cancer (IARC\/WHO)  Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dani\u00eblle A. 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