Integrating Legal Aid into HIV Care: Evaluating the Impact of a Medical-Legal Partnership on Viral Suppression Outcomes

Social and structural determinants of health (SSDoH), including legal challenges related to housing, employment, and public benefits, often obstruct HIV care adherence and viral suppression. Medical-Legal Partnerships (MLPs) have emerged as a promising structural intervention to mitigate these barriers but are underutilized in HIV service settings. This feasibility and acceptability trial evaluated the impact of an MLP intervention compared to treatment-as-usual (TAU) among people with HIV (PWH) in Philadelphia, Pennsylvania. Two matched service organizations were randomized to MLP or TAU. The MLP included interdisciplinary training, standardized legal screening by peer navigators, and integration of legal services from a legal aid organization. A total of 202 participants were enrolled using a multi-pronged recruitment strategy that included venue-based outreach, online recruitment methods, and peer referrals. Kaplan-Meier survival analyses and logistic regressions assessed the time to viral suppression and likelihood of achieving undetectable viral load at 3 and 6 months. Participants in the MLP site achieved undetectable viral load faster than those in the TAU site in both conservative and robust survival analyses. At 3-month follow-up, MLP participants were significantly more likely to achieve viral suppression (OR = 2.42, 95% CI: 1.06, 5.49, p =.03). Although the 6-month odds ratio was reduced (OR = 2.28, 95% CI: 0.79, 6.57), it did not reach statistical significance. Findings suggest that MLPs can accelerate viral suppression among PWH by addressing health-harming legal needs. This study supports the integration of legal services into HIV care as a promising strategy to improve outcomes and reduce disparities.