Organizational Characteristics of Medical-legal Partnerships Serving People Living with HIV: Challenges and Opportunities

Abstract

Objectives

To investigate what characteristics and strategies of medical-legal partnerships (MLPs) proved to invaluable to improving outcomes for people with HIV (PWH). To understand the potential benefits of MLPs and challenges with their implementation.

Design

A mixed-method analysis was conducted using both categorical features of MLPs, including the person who carries out the screening for health harming legal needs, whether the MLP was community-based or an organization, and how legal services were provided, and number of services offered on-site or referral based on responses to a cross-sectional survey of MLPs. We conducted a multiple variable linear regression analysis with these variables in association to the main outcome measures.

Setting

We used an online survey questionnaire to gather data for the study.

Participants

Data came from a cross-sectional survey of MLP providers through a national survey of clinics, community-based organizations, and hospitals across the United States. This data used for this study used survey data from a previous NIH study that was already completed with prior IRB approval done. The data did not collect identifiable information about themselves or their patients and were compensated with a $30 gift card. Inclusion criteria for this survey were organizations that had a patient population with over 50% of their patients living with HIV.

Interventions

No intervention was carried out.

Main Outcome Measures

Percentage of patients in their clinic that have achieved HIV viral suppression and percentage of patients completing a follow-up appointment every 6 months.

Results

Analysis showed that having clinician posing as the initial screener for health harming legal needs was associated with a lower likelihood of completing a follow-up appointment for PWH (P<.05). We also found the community health organizations were associated with a greater number of patients achieving a suppressed HIV viral load (P<.10). Finally, we found that that the number of on-site services were associated with an improvement with bout outcome measures.

Conclusions

Study findings highlight factors impacting outcomes in HIV care. Notably, clinician-led screening for health harming legal needs linked to reduced follow-up appointments for PWH, signaling an imperative for improved clinician training. The presence of community health organizations and on-site services emerged as key contributors to enhanced outcomes, emphasizing comprehensive care approaches in HIV care. Further research is needed to document best practices and approaches within medical-legal partnerships to improve HIV care outcomes.

Disclosures

none.