title: Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?
abstract: METHODS
  Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs).
  
  
  OBJECTIVE
  To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity.
  
  
  METHODS
  Cross-sectional study using client records, 2009 - 2012.
  
  
  RESULTS
  Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk [RR] 4.4, P = 0.03) and partners of person living with HIV (RR 25.9, P < 0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive (RR 9.1, P < 0.001).
  
  
  CONCLUSIONS
  The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an 'opportunity' for the expansion of the current service package.
authors.affiliation: National HIV/AIDS & STIs Control Programme, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan.
authors.forename: L
authors.initials: L
authors.lastname: Khandu
authors.affiliation: Operational Research Unit (LuxOR), Operational Centre Brussels, Médecins Sans Frontières, Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: LuxOR, Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu.
authors.forename: D
authors.initials: D
authors.lastname: Wangchuk
authors.affiliation: National HIV/AIDS & STIs Control Programme, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan.
authors.forename: N
authors.initials: N
authors.lastname: Tshering
authors.affiliation: National HIV/AIDS Consultant (Pvt), PIE Solution, Thimphu, Bhutan.
authors.forename: D
authors.initials: D
authors.lastname: Wangmo
authors.affiliation: REACH, Chennai, India.
authors.forename: R
authors.initials: R
authors.lastname: Ananthakrishnan
authors.affiliation: Communicable Disease Division, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan.
authors.forename: T
authors.initials: T
authors.lastname: Dorji
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Regional Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
keywords: female sex workers; injection drug users; men having sex with men; most at-risk populations; transgenders