Background: After COVID-19 shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net HIV clinic in San Francisco, with greater decreases among people living with HIV (PLWH) experiencing homelessness. We sought to understand if (1) proactive outreach to provide social services, (2) scaling up of in-person visits, and (3) expansion of housing programs could reverse this decline.Methods: We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression, followed by interrupted time series (ITS) analysis to examine changes in the rate of viral suppression per month. Loss to follow-up was assessed via active clinic tracing.Findings: Data from 1,816 patients were included in the analysis, with a median age of 51 years, 12% female, 14% experiencing unstable housing/homelessness. After an initial decline with the shelter-in-place order, the adjusted odds of VS increased 1.34-fold over 13 months following institution of the the multi-component strategies (95% confidence interval (CI): 1.21-1.46). In the interrupted time series analysis, the odds of VS continuously increased 1.05-fold per month over the post-intervention period (95% CI: 1.01-1.08). Among PLWH previously experiencing homelessness who were permanently housed or placed in shelter-in-place hotels, the odds of VS were 1.94-fold higher (95% CI:1.05-3.59). The one-year loss to follow-up rate was 2.8 per person-year (95% CI: 2.2-3.5).Interpretation: After an initial destabilization in VS in a large safety-net clinic following SIP orders, the VS rate increased following scale-up of in-person visits, clinic outreach to patients, intensification of social services, and access to COVID-related housing programs during this time. The loss to follow-up rate was similar or lower compared to prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing assistance programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.Funding Information: This work was funded by NIH/NIAID R01AI158013 (M.A.S. M.G. K.A.C, M.O.J), NIH/NIAID R24AI067039 (K.A,C.), and NIH/NIAID P30AI027763 (M.G.)Declaration of Interests: MAS, DVG, MOJ, DH, KAC, SPB and MG report funding from the NIH during conduct of the study. KAC reports investigator-initiated grant support from Gilead Sciences and personal fees from Gilead Sciences outside the submitted work. DVG reports personal fees from Gilead Sciences outside the submitted work. All other authors have nothing to declare. Ethics Approval Statement: This study was approved by the UCSF IRB, and informed consent was not required given processes occurred as part of routine care/quality improvement.