{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T23:27:31Z","timestamp":1767828451126,"version":"3.49.0"},"reference-count":24,"publisher":"BMJ","issue":"7","funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,4,6]]},"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The Bhutanese Screening Programme recommends a Pap smear every 3\u2009years for women aged 25\u201365 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The \u2018REACH-Bhutan\u2019 study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Cross-sectional, population-based study of cervical cancer screening based on the\n                      <jats:italic>care<\/jats:italic>\n                      HPV test on self-collected samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Overall, 3648 women aged 30\u201360 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>\n                      Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using\n                      <jats:italic>care<\/jats:italic>\n                      HPV in Thimphu (the Bhutanese capital) referral laboratory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      Screening participation by geographic area, centre, age and travelling time. Previous screening history and\n                      <jats:italic>care<\/jats:italic>\n                      HPV positivity by selected characteristics of the participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In April\/May 2016, 2590 women (median age: 41) were enrolled. Study participation was 71% and significantly heterogeneous by BHU (range: 31%\u201396%). Participation decreased with increase in age (81% in women aged 30\u201339\u2009years; 59% in \u226550 years) and travelling time (90% in women living &lt;30\u2009min from the BHU vs 62% among those &gt;6\u2009hours away). 50% of participants reported no previous screening, with the proportion of never-screened women varying significantly by BHU (range: 2%\u201372%). 265 women (10%; 95%\u2009CI 9% to 11%) were\n                      <jats:italic>care<\/jats:italic>\n                      HPV positive, with a significant variation by BHU (range: 5%\u201319%) and number of sexual partners (prevalence ratio for \u22653\u2009vs 0\u20131, 1.55; 95%\u2009CI 1.05 to 2.27).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016309","type":"journal-article","created":{"date-parts":[[2017,7,19]],"date-time":"2017-07-19T20:10:25Z","timestamp":1500495025000},"page":"e016309","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Cervical cancer screening in rural Bhutan with the\n                    <i>care<\/i>\n                    HPV test on self-collected samples: an ongoing cross-sectional, population-based study (REACH-Bhutan)"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7322-1862","authenticated-orcid":false,"given":"Iacopo","family":"Baussano","sequence":"first","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangay","family":"Tshering","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Dewanthang Hospital, Samdrup Jongkhar, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tashi","family":"Choden","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulvio","family":"Lazzarato","sequence":"additional","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"},{"name":"Unit of Cancer Epidemiology, AOU Citt\u00e0 della Salute e della Scienza, Hospital of Turin, Turin, Italy"},{"name":"Department of Translational Medicine, University of Piemonte Orientale Avogadro, Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Tenet","sequence":"additional","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martyn","family":"Plummer","sequence":"additional","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M","family":"Clifford","sequence":"additional","affiliation":[{"name":"Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ugyen","family":"Tshomo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,7,19]]},"reference":[{"key":"2025121512501263000_7.7.e016309.1","unstructured":"Ervik M , Lam F , Ferlay J , et al . 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