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Establishing HIV transmission pathways in Bhutan: a modelling study
Nisaa Wulan1, Lekey Khandu2, Debra Ten Brink1
1Burnet Institute, Melbourne, Australia.
The Lancet Regional Health. Southeast Asia
|October 13, 2025
Summary
In Bhutan, 86% of new HIV infections in 2021 were among key populations and their networks. Targeted interventions are crucial for preventing new infections and identifying undiagnosed cases to eliminate HIV transmission.
Area of Science:
- Epidemiology
- Public Health
- Mathematical Modeling
Background:
- Limited data exists on HIV transmission and risk factors in Bhutan.
- Key populations face increased exposure risks to HIV.
Purpose of the Study:
- To explore comprehensive pathways to HIV infections among key populations in Bhutan.
- To inform HIV prevention and control strategies.
Main Methods:
- Utilized demographic, epidemiological, and behavioral data.
- Developed and calibrated an Optima HIV model for Bhutan (1990-2021).
- Incorporated qualitative feedback and aligned with EPP-Spectrum model outputs.
Main Results:
- In 2021, 54% of new HIV infections were linked to sex work.
- 86% of new infections occurred within key/vulnerable populations and their networks.
- HIV prevalence among key populations ranged from 0.7% to 3.1%.
Conclusions:
- Current interventions focused on key populations may not reach all undiagnosed individuals.
- Enhanced strategies are needed to prevent new infections and identify existing cases.
- Combined efforts are essential for HIV transmission elimination in Bhutan.

