Investigator(s)
| Submitter |
Deki Phuntsho MoH Deki Phuntsho 
|
| Principal Investigator |
Deki Phuntsho MoH Deki Phuntsho
|
| Co-Investigator(s) |
Namgay Tshering Under supervision of NACP, CDD, DoPH, MoH Namgay Tshering
|
Title(s) and abstract
| Scientific title | National Sentinel Sero-Surveillance of HIV, Hepatitis B (HBsAg), Syphilis (RPR & TPHA) among Key Populations in Bhutan, 2026 |
| Public title | Sentinel surveillance |
| Background | Globally, key populations (KPs)—including sex workers, men who have sex with men (MSM), and transgender individuals account for more than 65% of new HIV infections (UNAIDS, 2023). In South Asia, stigma, discrimination, criminalization, and structural barriers continue to limit access to HIV prevention, testing, and treatment services among these populations (WHO, 2022). Bhutan remains a low-prevalence HIV setting, with a cumulative total of 1,047 detected HIV cases as of June 2025 and an estimated 1,100 people living with HIV (UNAIDS). Despite high ART coverage, evidence suggests under-diagnosis among key populations due to stigma, hidden networks, and limited disaggregation of KP data in routine surveillance systems. The 2019–2020 Population Size Estimation (PSE) and hotspot mapping exercise identified significant populations of High-Risk Women (HRW), MSM, Transgender Women (TGW), and Transgender Men (TGM), along with high-risk behaviours and service gaps (Ministry of Health, Bhutan, 2020).Bhutan’s first Key Population HIV Sentinel Surveillance (HSS) conducted in 2021 demonstrated feasibility of Peer-Driven Recruitment (PDR) and Lot Quality Assurance (LQA) approaches (Ministry of Health, Bhutan, 2020), while highlighting the need for stronger methodological rigor and operational standardization. This 2026 surveillance builds on the 2021 sentinel design and strengthens it to generate epidemiologically robust and programmatically actionable evidence for Bhutan’s HIV response. |
| Objectives | General Objective To generate epidemiologically robust and programmatically relevant data on the prevalence of HIV, Hepatitis B, and Syphilis and associated behavioural risk factors among key populations in Bhutan. 2.2 Specific Objectives 1. Estimate prevalence of HIV, HBsAg, and Syphilis among HRW, MSM, TGW, and TGM 2. Detect early signals of increasing HIV transmission using LQA methodology 3. Assess behavioural risk factors, stigma, and service uptake 4. Evaluate linkage to testing, care, and prevention services |
| Study Methods | Study Design Cross-sectional sentinel sero-surveillance using: • Peer-Driven Recruitment (PDR) • Community-based behavioural and biological data collection • Lot Quality Assurance Sampling (LQA) 3.1 Study Setting The study will be conducted in community-based settings across Five sentinel dzongkhags: Thimphu, Paro, Chhukha (Phuentsholing), Sarpang (Gelephu) and Samdrup Jongkhar. Data collection will occur in identified hotspots such as entertainment venues, lodges, and outreach sites. Confidential temporary spaces will be established to ensure privacy during consent, interviews, and biological sample collection. |
| Expected outcomes and use of results | The expected outcome of the National Sentinel Sero-Surveillance 2026 is to provide a robust epidemiological and programmatic snapshot of the HIV, Hepatitis B, and Syphilis landscape among key populations (HRW, MSM, TGW, and TGM) in Bhutan.Key anticipated results include:Prevalence Data and Early Warning Signals: Accurate estimation of HIV, HBsAg, and Syphilis prevalence within these groups, utilizing the Lot Quality Assurance (LQA) methodology to detect if HIV transmission has exceeded critical thresholds (specifically the 5% threshold).Behavioral Risk Assessment: A clearer understanding of current risk factors, including condom use consistency, sexual partner counts, and existing levels of stigma or discrimination in healthcare settings.Service Uptake and Linkage Gap Analysis: Identification of barriers to accessing health services and an evaluation of the effectiveness of current testing and referral pathways.Programmatic and Policy Evidence: The generation of actionable evidence to strengthen Bhutan’s HIV response, disseminated through national workshops and policy briefs to improve future prevention and treatment strategies.Enhanced Public Health Action: Immediate linkage to care for individuals testing reactive during the study and triggered community interventions in areas where high prevalence is detected. |
| Keywords | The 2026 National Sentinel Sero-Surveillance in Bhutan focuses on the prevalence of HIV, Hepatitis B (HBsAg), and Syphilis (RPR & TPHA) among Key Populations (KPs) , specifically High-Risk Women (HRW), Men who have Sex with Men (MSM), Transgender Women |
Research Details
| Student research | No |
| Start Date | 15-Apr-2026 |
| End Date | 15-Jun-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | HIV/AIDS |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | No |