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By Natalie Shure

In the years since I developed drug-resistant tuberculosis (DR-TB) in 2010, the field has welcomed several scientific advances that would have fundamentally changed my experience of living with the disease. For one thing, my two- year treatment course, anchored by painful injectables and inconvenient infusions that warped my hearing, could likely be replaced with a six-month all-oral regimen today. The process to test drug susceptibility on TB cultures that took weeks in 2010 can now be completed in two hours on a GeneXpert machine, and the then six-month preventive treatment doled out to close contacts can now be accomplished in as little as one month. And scientific research of the not-so-distant past has had an even more dramatic impact on HIV and HCV, with the introduction of combination antiretroviral therapy (ART) and direct-acting antivirals greatly improving the prognosis of anyone who acquires these viruses.

All told, the state of the science surrounding HIV, TB, and HCV today is on much more solid ground than it has been in decades past. Years of community-led advocacy for research into better prevention, diagnostics, and treatment — much of it still ongoing — have finally paid off.

Yet scientifically validated new tools can only do so much on their own. As anyone who works in HIV, TB, and HCV knows, even the most groundbreaking scientific research can’t implement itself. Information about emerging and longtime frontline treatment, not to mention drugs themselves, still aren’t making their way to everyone who needs them. Nearly a quarter of people living with HIV around the world are not currently accessing ART, and fewer than a quarter of people who could benefit from preexposure prophylaxis (PrEP) are currently taking it. Over three-quarters of people with HCV have not been treated, and fewer than 60% of people living with TB disease are on treatment — even fewer for drug- resistant TB and for children. Throughout the TB prevention and care cascades, updated tools and insights — gold standard testing strategies, most effective regimens, research on effective psychosocial interventions — are delayed or denied over the course of their translation from research studies into practice in people’s lives.

For the 2023 issue of TAGline, we take a closer look at just a few of the multitude of factors that contribute toward science getting lost in translation from the laboratory to real-world settings. Making this process faster and smoother could be the difference between an arduous, unacceptable intervention and a convenient one, a minimal failure rate or a moderate one, suppression or cure and ongoing transmission, or even life and death. The articles that follow go beyond merely analyzing barriers to implementing research that could result in progress toward ending HIV, TB, and HCV to discuss how various actors could rise to meet these challenges.

Lynette Mabote-Eyde and Mike Frick take stock of the state of TB preventive treatment (TPT) around the world, exploring nuances that help explain why newly validated TPT regimens still aren’t universally used by household contacts of people living with active TB disease. While previous iterations of TPT lasted for six to nine months or more and caused considerable liver toxicity, the more recently introduced 1HP and 3HP — meaning one month of daily isoniazid (H) and rifapentine (P), or three months of once-weekly H and P — regimens using rifapentine can now prevent TB in as little as one or three months with relatively minimal side effects. They point to issues including inadequate contact tracing, rifapentine shortages, and low public awareness of advances as reasons TPT isn’t catching on as quickly as it should be and highlight community partnerships through the Aurum Institute’s IMPAACT4TB initiative as a model for increasing uptake of 1HP and 3HP in high-burden communities.

De’Ashia Lee, Kendall Martinez-Wright, and Lizzy Lovinger warn that rising anti-LGBTQ+ sentiment in the United States and around the world poses an existential threat to public health. They walk readers through research on how homophobia and the legal landscape affect things such as HIV testing and access to care, concluding that recent legislation and political events are creating hostile environments in many jurisdictions where LGBTQ+ people are being stigmatized, discriminated against, and driven away from services where they might access evidence-based interventions to preserve their health and lives.

Erin McConnell offers a somber assessment of how social media supercharges anti-vaccine movements, turning people away from these lifesaving prevention tools. She reminds us that ensuring research doesn’t get lost in translation requires proactive early action, arguing that digital advocacy must be part of vaccine preparedness and rollout strategies for future vaccines, including those for HIV, TB, and HCV.

Finally, Joelle Dountio Ofimboudem and Sara Helena Gaspar look to reimagine HCV elimination strategies now that intellectual property is no longer restricting access to generic cures. They explore how the lack of political will, under-resourced national-level regulatory bodies, countries’ failure to modernize guidelines for diagnosis and harm reduction to reflect best available evidence, and a lack of funding are preventing DAAs from wider dissemination.

Ultimately, the questions explored in this edition of TAGline are at the heart of our work. By fighting for affected-community engagement at every step of the research, development, implementation, and policymaking process, we aim both to advocate for the generation of useful scientific research and also to ensure it translates into meaningful benefits for people living with HIV, TB, and HCV.

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