Cervical cancer screening in rural Bhutan with the <i>care</i>HPV test on self-collected samples: an ongoing cross-sectional, population-based study (REACH-Bhutan).

Abstract

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. Cross-sectional, population-based study of cervical cancer screening based on the <i>care</i>HPV test on self-collected samples. Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan. Overall, 3648 women aged 30-60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population. Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using <i>care</i>HPV in Thimphu (the Bhutanese capital) referral laboratory. Screening participation by geographic area, centre, age and travelling time. Previous screening history and <i>care</i>HPV positivity by selected characteristics of the participants. 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 <i>care</i>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). 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.