Examining the impact of medical legal partnerships in improving outcomes on the HIV care continuum: rationale, design and methods

Miguel Muñoz-Laboy,Omar Martinez,Isa Fernandez,Robin Davison

doi:10.1186/s12913-019-4632-x

Miguel Muñoz-Laboy, Omar Martinez + Show 2 more

Open Access

https://doi.org/10.1186/s12913-019-4632-x

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Abstract

BackgroundOver 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 health care settings, the health outcomes efficacy of MLPs has yet to be examined, particularly for complex chronic conditions such as HIV.MethodsThis on-going mixed-methods study utilizes institutional case study and intervention mapping methodologies to develop an HIV-specific medical legal partnership logic model. Up-to-date, the organizational qualitative data has been collected. The next steps of this study consists of: (1) recruitment of 100 MLP providers through a national survey of clinics, community-based organizations, and hospitals; (2) in-depth interviewing of 50 dyads of MLP service providers and clients living with HIV to gauge the potential large-scale impact of legal partnerships on addressing the unmet needs of this population; and, (3) the development of an MLP intervention model to improve HIV care continuum outcomes using intervention mapping.DiscussionThe proposed study is highly significant because it targets a vulnerable population, PLWHA, and consists of formative and developmental work to investigate the impact of MLPs on health, legal, and psychosocial outcomes within this population. MLPs offer an integrated approach to healthcare delivery that seems promising for meeting the needs of PLWHA, but has yet to be rigorously assessed within this population.

Highlights

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
Methods/design The aim of this paper is to describe the methodology to design a structural intervention to improve Human Immunodeficiency Virus (HIV) care continuum outcomes for people living with HIV
Most of the interventions designed using intervention mapping range in levels of intervention from individual, families, and practitioners to organizational and community levels practices; and in types of conditions ranging from prevention of communicable diseases and early detection of chronic conditions to behavioral management of long-term chronic conditions [19, 20, 22,23,24,25]

Summary

Introduction

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. The specific objectives of this ongoing study are: (1) To identify existing best practices among current MLPs that can be tested, replicated, and scaled-up as evidence-based practices for serving the plurality of PLWH; (2) To assess the effects of the identified MLP practices on: a) appropriately addressing the legal issues through clients’ satisfaction and case outcomes, b) reducing the legally-related psychosocial burdens for PLWH, and, c) increasing positive movement in the HIV continuum of care (including retention in care and viral load suppression) among PLWH. The specific objectives of this ongoing study are: (1) To identify existing best practices among current MLPs that can be tested, replicated, and scaled-up as evidence-based practices for serving the plurality of PLWH; (2) To assess the effects of the identified MLP practices on: a) appropriately addressing the legal issues through clients’ satisfaction and case outcomes, b) reducing the legally-related psychosocial burdens for PLWH, and, c) increasing positive movement in the HIV continuum of care (including retention in care and viral load suppression) among PLWH. (3) To develop an MLP-comprehensive HIV care diffusion model and its benchmarks of success to achieve positive movement in the HIV continuum of care (including retention in care and viral load suppression) for diverse sectors of PLWH

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