Missouri Institute of Mental Health

Abstract Background The use of FTC/TAF (Descovy) was approved for PrEP by the FDA or men who sex with men (MSM). People of color (POC) are disproportionately affected by HIV and less likely to use PrEP due to barriers to access. Telehealth approaches may reduce barriers and improve uptake of PrPE in the MSM population. Study Participants vs historical controls Methods We recruited MSM and transgender females who ere hIV negative, 18 years and older, had not used PrEP for > 30 days in the last year and had internet access from three Vivent Health clinics (Denver, Milwaukee and St Louis). We advertised the Telehealth PrEP intervention over social media, in-person at LGBTQIA+ events, and in surrounding rural areas. Participants were consented via the internet or in person. HIV testing was done vial oral swab, and PrEP was initiated during a Telehealth visit, and FTC/TAF was sent to their homes. A 3- month follow-up Telehealth visit was conducted. We describe demographics, retention at 3-months compared to historical controls who had initiated PrEP through routine care at these clinics using chi-square tests. An electronic Likert questionnaire was sent to study participants and staff. Results Overall, 75 participants were recruited at three sites: 30 in Denver (40.0%), 22 in Milwaukee (29.3%) and 23 in St. Louis (30.7%). Median age was 34 years (IQR 27,43) and 62 were male (82.7%), 4 were transgender female (5.3%) and 3(4%) were nonbinary (male). Forty-one (54.7%) were non-Hispanic White, 12 (16.0%) were Black/African-American, 14(18.7%) were Latino and 6 (8.0%) were Asian. There were no HIV seroconversions among study participants: 48(64.0%) completed their 3-month follow-up visit (44 [93.6%] virtual only,1 [2.1%] in-person only, and 3 [6.3%] both). Demographics o those initiation PrEP were similar to historical controls. Almost 90% of study participants were satisfied with their telehealth visit and 100% would recommend Telehealth visit. While 100% of staff would recommend Telehealth, only 40% were satified with the telehealth visit. Conclusion PrEP initiation and follow-up via Telehealth resulted in similar short-term persistence as routine in person care but was not more successful in improving prEP uptake among marginalized groups. Other modalities are needed to improve uptake of PrEP for POC. Disclosures Cynthia Firnhaber, MD, MS, DTM&H, MERCK: Advisor/Consultant|MERCK: Grant/Research Support Aaloke Mody, MD, Gilead: Grant/Research Support

Peer support workers (PSWs) are trained behavioral health professionals with lived experience of substance use disorders. PSWs are employed by behavioral health agencies to increase uptake of and retention in treatment and recovery services. As their presence in these settings grows, it remains unclear how well PSW job functions align with their unique skills and personal experiences. To fill this gap, a content analysis of online job postings for PSW roles in Missouri across geographic regions and types of behavioral healthcare settings (i.e., treatment facilities, recovery housing, recovery community centers, hospitals, criminal justice settings) posted between April 2023 and September 2024 was conducted and analyzed to assess how they reflect role expectations and the distinct value PSWs contribute to the system. Job tasks were organized into categories and classified as authentic (utilizing PSWs' experience and training, e.g., mentoring, recovery goal setting, and peer advocacy) or generic (not specific to peer roles, e.g., administrative duties, transportation, maintaining relationships with external stakeholders). Results showed that PSWs are expected to perform a near even split of authentic (49.8%) and generic (50.2%) tasks. These findings suggest a lack of consistency in how agencies define and implement the PSW role, potentially contributing to job dissatisfaction and turnover. As organizations continue to employ PSWs in greater numbers, it will be important for agencies to prioritize job clarity and satisfaction, as well as determine the optimal balance of tasks for a more consistent system-level understanding of how to best utilize PSWs in the workplace.

Abstract Ecological Momentary Assessment (EMA) may be useful in the surgical setting for predicting and monitoring symptoms including perioperative pain. However, no largescale studies have established the feasibility of perioperative EMA. The Personalized Prediction of Persistent Postsurgical Pain (P5) study includes collection of perioperative EMA in a cohort of 2,500 patients who underwent major surgery in the Midwestern United States. Despite EMA not being required nor directly incentivized, 91% of participants completed any EMA. Demographic and clinical characteristics were largely similar between those who did and did not complete EMA, except for insurance status. Participants who did not complete any EMA were more likely to be using Medicare (38% vs. 28%) or Medicaid (20% vs. 11%). Without excluding participants based on low compliance, we observed high preoperative (Median = 80%) and postoperative (Median = 72%) compliance with EMAs delivered three times per day. Compliance was somewhat lower among individuals with worse mental and physical health symptoms, though effect sizes were small. Sociodemographic characteristics were associated with both pre- and postoperative EMA compliance, such that men who identified as Black/African heritage responded to fewer than 50% of surveys on average. Individuals who used Medicaid and those with lower educational attainment also exhibited lower compliance. Overall, EMA appears feasible in the surgical setting. However, knowledge of these disparities is critical to ensuring that EMA research is generalizable, as individuals who provide less data will be less influence in statistical models without proper handling of missing data.

BackgroundDespite significant efforts to address the opioid overdose crisis, Black people who use drugs (PWUD) face unabating, disproportionate increases in opioid overdose death (OOD) rates. These inequities persist in treatment admissions, utilization of medication for opioid use disorder, and treatment retention. Research has linked neighborhood disinvestment — a process of urban decline driven by policy-related changes in neighborhood demand and desirability leading to decreased population, physical and economic erosion, and poorer quality of life for residents — to increased rates of OOD. However, given recent increases in OOD inequities, more research is needed to determine the specific aspects of neighborhood disinvestment that drive OOD risk among Black PWUD.MethodsThe current qualitative study utilized a community-engaged research approach to conduct focus groups with stakeholders providing support to PWUD in Black neighborhoods in order to identify the facets of neighborhood disinvestment that contribute and mitigate increases of OOD among Black PWUD in St. Louis, Missouri.ResultsThe resulting thematic analysis identified four themes linking neighborhood disinvestment to increased rates of OOD among Black PWUD: (1) a lack of access to congruent treatment and services, (2) intergenerational and socioemotional lack of mobility, (3) lack of financial accountability and investment from local leadership and government, and (4) the loss of collective community responsibility and engagement. A fifth theme brought attention to a culturally-grounded strategy being used to reduce these rates: (5) building engagement and community cohesion through grassroots efforts and street outreach.ConclusionsFindings provide key implications for policy and practice, including the importance of adopting a community-based research framework, offering financial management training for Black-led organizations, and harnessing community champions to implement culturally-tailored interventions aimed at reducing stigma and raising critical consciousness. Future work should aim to identify more effective community-driven solutions to address OOD in Black neighborhoods.

GABAA receptors containing δ subunits have been shown to mediate tonic/slow inhibition in the CNS. These receptors are typically found extrasynaptically and are activated by relatively low levels of ambient GABA in the extracellular space. In the mouse neocortex, δ subunits are expressed by some pyramidal cells as well as on parvalbumin-positive (PV+) interneurons. An important function of PV+ interneurons is the organization of coordinated network activity that can be measured by EEG. However, it remains unclear what role tonic/slow inhibitory control of PV+ neurons may play in shaping oscillatory activity. After validating expected functional loss of δ-associated current in cortex of PV δcKO mice of both sexes, we performed EEG recordings to survey network activity across wake and sleep states. PV δcKO mice showed altered spectral content of EEG during NREM and REM sleep that was a result of increased oscillatory activity in NREM and the emergence of transient high-amplitude bursts of theta-frequency activity during REM. Viral reintroduction of Gabrd to PV+ interneurons in PV δcKO mice rescued REM EEG phenotypes, supporting an important role for δ subunit-mediated inhibition of PV+ interneurons for maintaining normal REM cortical oscillations.

Adolescents with perinatally acquired HIV (AWH) are at an increased risk of poor cognitive development yet the underlying mechanisms remain unclear. Circulating galectin-9 (Gal-9) has been associated with increased inflammation and multimorbidity in adults with HIV despite antiretroviral therapy (ART); however, the relationship between Gal-9 in AWH and cognition remain unexplored. A cross-sectional study of two independent age-matched cohorts from India [AWH on ART ( n = 15), ART-naive ( n = 15), and adolescents without HIV (AWOH; n = 10)] and Myanmar [AWH on ART ( n = 54) and AWOH ( n = 22)] were studied. Adolescents from Myanmar underwent standardized cognitive tests. Plasma Gal-9 and soluble mediators were measured by immunoassays and cellular immune markers by flow cytometry. We used Mann-Whitney U tests to determine group-wise differences, Spearman's correlation for associations and machine learning to identify a classifier of cognitive status (impaired vs. unimpaired) built from clinical (age, sex, HIV status) and immunological markers. Gal-9 levels were elevated in ART-treated AWH compared with AWOH in both cohorts (all P < 0.05). Higher Gal-9 in AWH correlated with increased levels of inflammatory mediators (sCD14, TNFα, MCP-1, IP-10, IL-10) and activated CD8 + T cells (all P < 0.05). Irrespective of HIV status, higher Gal-9 levels correlated with lower cognitive test scores in multiple domains [verbal learning, visuospatial learning, memory, motor skills (all P < 0.05)]. ML classification identified Gal-9, CTLA-4, HVEM, and TIM-3 as significant predictors of cognitive deficits in adolescents [mean area under the curve (AUC) = 0.837]. Our results highlight a potential role of Gal-9 as a biomarker of inflammation and cognitive health among adolescents with perinatally acquired HIV.