Worldwide, people with mental disorders are detained within the justice system at higher rates than the general population and often suffer human rights abuses. This review sought to understand the state of knowledge on the mental health of people detained in the justice system in Africa, including epidemiology, conditions of detention, and interventions. We included all primary research studies examining mental disorders or mental health policy related to detention within the justice system in Africa. 80 met inclusion criteria. 67% were prevalence studies and meta-analysis of these studies revealed pooled prevalence as follows: substance use 38% (95% CI 26–50%), mood disorders 22% (95% CI 16–28%), and psychotic disorders 33% (95% CI 28–37%). There were only three studies of interventions. Studies examined prisons (46%), forensic hospital settings (37%), youth institutions (13%), or the health system (4%). In 36% of studies, the majority of participants had not been convicted of a crime. Given the high heterogeneity in subpopulations identified in this review, future research should examine context and population-specific interventions for people with mental disorders. Electronic supplementary material The online version of this article (10.1186/s13033-019-0273-z) contains supplementary material, which is available to authorized users.

Background Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective In this study, we introduced an existing PrEP adherence app to new potential users—BMSM engaged in PrEP care in New Orleans—to guide app adaptation with STI prevention features and tailoring for the local context. Methods Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep’d app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes.

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BACKGROUND Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). OBJECTIVE In this study, we introduced an existing PrEP adherence app to new potential users in New Orleans, Louisiana to guide app adaptation with STI prevention features and tailoring for the local context. METHODS Four FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into four categories: STI prevention, app preferences, impressions of the app prototype, and adaptations. Participants desired STI prevention strategies and suggested prevention methods to implement through the app. They emphasized the need for an app to offer relevant features and be easy-to-use. Participants thought the current app was useful and generally liked the existing features. They had suggestions for modifications for STI prevention, such as the ability to track and comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. RESULTS Four FGDs were conducted with 24 BMSM taking PrEP. Themes are grouped into four categories: STI prevention, app preferences, impressions of the app prototype, and adaptations. Participants desired STI prevention strategies and suggested prevention methods to implement through the app. They emphasized the need for an app to offer relevant features and be easy-to-use. Participants thought the current app was useful and generally liked the existing features. They had suggestions for modifications for STI prevention, such as the ability to track and comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. CONCLUSIONS A PrEP adherence app was iteratively adapted with feedback from Black MSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Next steps will assess usage and STI prevention outcomes.

Background Anti-retroviral therapy (ART) has been associated with significant weight gain and metabolic derangements in persons with HIV (PWH), and many PWH on ART experience comorbid obesity. GLP-1 receptor agonists (GLP-1RA) are used to treat type-2 diabetes and obesity in people without HIV infection, but data on the use of these agents in PWH on ART are limited. Methods We extracted data from electronic medical records of PWH on ART receiving care at a clinic in New Orleans, LA who had been started on GLP-1RA therapy. We tracked weight (change in body weight, body mass index [BMI]) and changes in hemoglobin A1c (Hba1c) over time from initiation of GLP-1RA to April 2022. A control group of PWH on metformin only will be compared to those on GLP-1RA at a later stage of analysis. Results Of 35 PWH on GLP-1RA, the mean age was 55.2 (standard deviation [SD] 10.0); 29 (83%) were Black/African American, 14 (40%) were assigned female at birth, 21 (60%) were assigned male at birth, and 2 were non-binary. Average BMI was 35.7 (SD 9.8) and average HbA1c was 9.5 (SD 2.6) at baseline. Integrase inhibitors were prescribed for 31 (89%) and metformin was prescribed for 20 (57%). Other baseline characteristics are shown in Figure 1. Mean duration of GLP-1RA therapy was 20.6 months (SD 14.0), and 20 (57%) had greater than 12 months of follow-up. Most (23, 66%) on GLP-1RA lost weight, 3 (9%) had a stable weight, and 9 (26%) gained weight. Five percent or more of body weight was lost by 11 (31%) of the total cohort (those with any amount of time on GLP-1RA) and by 9/20 (45%) of those on GLP-1RA for more than 12 months. Conclusion Our data show moderate weight loss among PWH on GLP-1RA. This study is limited by small sample size and limited follow-up time. Further research is needed to determine whether GLP-1RAs are an effective treatment option for obesity in PWH. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Roche: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant|Viiv Healthcare: Grant/Research Support.