An Inquire of Cost and Benefits of Structural Interventions: The Case of Medical Legal Partnerships for People Living with HIV in Philadelphia, PA

Abstract

The net benefits of medical legal partnerships (MLP), providers of legal service for HIV-infected individuals in clinical settings, is gaining importance in the economic evaluation literature. MLP are structural interventions designed to improve HIV care continuum outcomes beyond the epidemiological and behavioral approaches. This paper introduces a theoretical framework for the economic evaluation and impact of MLP as well as identifies the highest return on the program based on costs, resources, and risk involved. The intervention package includes training for all MLP care providers, a screening tool and protocol that is designed to identify PLWH patients’ health-harming legal needs, and provision of legal support through partnership with a local public interest law clinic. The intervention is conceptualized as a clustered-randomized small-scale trial in two HIV treatment services organizations in Philadelphia, PA. Our approach to addressing health-harming legal needs for PLWH is based on integrated care principles and co-location of services. A cost-benefit analysis will determine the program’s feasibility.