Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Lauretta E. Grau

Second Advisor

Patrick B. Ryan


IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health Data Sciences and Informatics (OHDSI) framework.4–6 Observed treatment patterns were identified, evaluated over time, and compared to current US clinical guidelines for HIV treatment. Results We identified over 4000 unique sequences of ART prescriptions. The majority of individuals remained on their initial treatment regimen and 86.8% of individuals use fixed-dose medications which reduced the frequency of regimen alteration. ART medication utilization changed substantially from 2012-2021 but remained primarily consistent across the different patient populations evaluated, which included commercially insured individuals and individuals on Medicaid. Conclusions The treatment pathways revealed that ART changed substantially from 2012-2021, with regimens including more novel therapy options consistent with clinical guidelines becoming more widely utilized after regulatory approval. Our findings highlight the preferability of fixed-dose combination products to simplify regimens, increase adherence, and improve the health outcomes of people living with HIV. ART patterns were primarily consistent across the four databases that represented different healthcare service providers and patient populations. This study characterizes patterns in ART to provide insight into the evolution of therapeutic strategies in HIV treatment and care over the last decade.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025