Investigator(s)
| Submitter |
LOBZANG TSHERING District Health Sector, District Administration, Trashigang, Bhutan. Currently undergoing MSc. Epidemiology, Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Thailand. LOBZANG TSHERING 
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| Principal Investigator |
LOBZANG TSHERING District Health Sector, District Administration, Trashigang, Bhutan. Currently undergoing MSc. Epidemiology, Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Thailand. LOBZANG TSHERING
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| Co-Investigator(s) |
Dr. Tippawan Liabsuetrakul Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University Thailand. Dr. Tippawan Liabsuetrakul
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| Co-Investigator(s) |
Dr. Kasemsak Jandee Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University Thailand. Dr. Kasemsak Jandee
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Title(s) and abstract
| Scientific title | Assessment of supply-side capacity and demand-side intention for repeat HPV-based cervical cancer screening in Eastern Bhutan: A Cross-Sectional Study |
| Public title | Assessment of supply-side capacity and demand-side intention for repeat HPV-based cervical cancer screening in Eastern Bhutan: A Cross-Sectional Study |
| Background | Cervical cancer is one of the most common cancers among women worldwide, with approximately 660,000 new cases and 350,000 deaths annually. Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer. Although HPV vaccination is an effective primary prevention strategy, its implementation remains limited in many low- and middle-income countries (LMICs). Therefore, HPV-based cervical cancer screening and timely treatment of precancerous lesions remain essential secondary prevention measures. The World Health Organization (WHO) recommends HPV testing as the primary screening method because it is more sensitive and effective than cytology. Women with negative HPV test results have a very low risk of developing cervical precancer and are generally advised to repeat screening every five years. Bhutan introduced nationwide laboratory-based HPV screening in 2020 and has achieved high screening coverage and treatment rates under its national cervical cancer elimination programme. Successful implementation of HPV-based screening depends on both supply-side capacity and demand-side readiness. Supply-side capacity refers to the ability of health facilities to provide screening through adequate infrastructure, trained personnel, laboratory services, equipment, supplies, and logistics. Demand-side readiness reflects women's willingness and intention to participate in screening, which may be influenced by knowledge, attitudes, perceived control, misconceptions, fear, and embarrassment. Although Bhutan has achieved high national screening coverage and met the WHO 90-70-90 cervical cancer elimination targets, limited evidence exists on health system preparedness and women's intention to undergo repeat HPV screening. Assessing both supply-side capacity and demand-side intention is therefore essential to identify service gaps and inform strategies for sustaining and strengthening HPV-based cervical cancer screening in Eastern Bhutan. |
| Objectives | • To evaluate supply-side availability and readiness for HPV-based cervical cancer screening. • To assess the demand-side intention for repeat HPV-based cervical screening among women aged 30 - 65 years with negative results from the national screening program in eastern Bhutan and associated factors. • To identify the supply-demand gap for HPV-based cervical cancer screening in Eastern Bhutan. |
| Study Methods | Supply-side methodology: A facility-based cross-sectional study will be conducted from July to December 2026 across the six districts of Eastern Bhutan. The study will assess the availability and readiness of health facilities to provide HPV-based cervical cancer screening services. All 20 hospitals and a simple random sample of 39 (50%) Primary Health Centres (PHCs) will be included, giving a total of 59 health facilities. Data will be collected using a structured assessment tool adapted from the WHO Service Availability and Readiness Assessment (SARA) framework and the CervScreen-SARA tool. The assessment will cover governance, infrastructure, human resources, supplies, monitoring, logistics, infection prevention, and service readiness. Demand-side methodology: A community-based cross-sectional study will be conducted from July to December 2026 in the catchment areas of the selected hospitals and Primary Health Centres (PHCs) across six districts in Eastern Bhutan. The study will include women aged 30-65 years who have resided in the area for at least 12 months and previously received a negative HPV DNA test result. A total of 640 participants will be selected using simple random sampling from facility records, with equal allocation between hospitals (320) and PHCs (320). Eligible women will be interviewed at their households using a structured questionnaire to assess their intention to undergo repeat HPV-based cervical cancer screening. |
| Expected outcomes and use of results | Expected Outcomes • The study will generate evidence on the availability and readiness of health facilities to provide HPV-based cervical cancer screening services in Eastern Bhutan, including human resources, equipment, supplies, laboratory capacity, and service delivery systems. • The study will determine the level of intention among women aged 30-65 years with previous negative HPV test results to undergo repeat HPV-based cervical cancer screening and identify factors associated with their intention. • The study will identify existing gaps between the health system's capacity to provide HPV screening services and women's intention to utilize these services. • The study will provide baseline information on the preparedness of both the health system and the target population for sustaining the national HPV-based cervical cancer screening programme. Use of Results • The findings will assist the Ministry of Health in strengthening cervical cancer prevention and control strategies, particularly for repeat HPV screening services. • The results will help policymakers and program managers identify priority areas for improving health facility readiness, workforce capacity, logistics, and service delivery. • The findings will support the development of targeted health education and community engagement interventions to improve women's participation in repeat HPV screening. • The evidence generated will contribute to monitoring and sustaining Bhutan's progress towards the WHO cervical cancer elimination targets and may serve as a reference for future research and program planning. |
| Keywords | HPV testing; Cervical cancer screening; Health facility readiness; women’s intention; Repeat screening; Bhutan. |
Research Details
| Student research | Yes |
| Institution: Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Thailand. | |
| Academic degree: Master | |
| Supervisor of the student(s) | |
| Full Name and title: Professor Dr. Tippawan Liabsuetrakul | |
| Email: tippawan.l@psu.ac.th | |
| Start Date | 01-Aug-2026 |
| End Date | 30-Nov-2026 |
| Key Implementing Institution | Prince of Songkla University |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Reproductive Health |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | No |