Project Summary
Over the past two decades, we have seen a nationwide increase in the use of medical-legal partnerships
(MLPs) to address health disparities affecting vulnerable populations. These partnerships increase medical
teams' capacity to address social and environmental threats to patients' health, such as unsafe housing
conditions, through partnership with legal professionals. Despite expansions in the use of MLP care models in
hospitals and clinics, formative work to evaluate this approach and test its efficacy to promote HIV care and
wellness among people living with HIV (PLWH) has yet to be conducted. Building on gaps in the current
literature, we propose a mixed-methods study to develop an MLP-comprehensive HIV care diffusion model to
build an understanding of avenues through which such partnerships can improve outcomes in the HIV care
continuum. First, a national survey of 100 medical-legal partnership service providers from the existing 294
medical-legal partnership programs will be conducted to identify and assess existing best practices among
current MLPs. Next, in-depth interviews with 50 dyad-based interviews of MLP service providers and HIV
positive clients will be conducted to gauge the potential large-scale impact of legal partnerships on addressing
legal problems, reducing legally-related psychosocial burdens, and improving outcomes in the HIV care
continuum, including engagement in care and viral load suppression. We will then develop an MLP-
comprehensive HIV care diffusion model and its benchmarks of success based on data grained through Aims
1 and 2. We will use Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to develop
an MLP-comprehensive HIV care diffusion model and its benchmarks of success to improve outcomes in the
HIV care continuum. The model will be tested in a subsequent R34 submission using a Sequential Multiple
Assignment Randomized Trial (SMART) design for evaluating adaptive interventions. The proposed study
builds on the investigative team's experience with HIV Law research, as well as consultants' record of HIV
research and experience with MLP implementation. To our knowledge, this study will be the first to examine
the impact of MLPs on outcomes in the HIV care continuum. Rigorous methodology, including detailed
documentation of quantitative and qualitative components, will ensure that this study may be scaled up and
replicated in various communities to provide continuous support, integration of care, and protection for this
heavily impacted group.