Optimizing Medications and Lung Health in People With HIV Through Pharmacist-led Proactive E-Consults

People with HIV (PWH) continue to experience elevated risk of community-acquired pneumonia despite effective antiretroviral therapy. Pneumonia contributes to hospitalization, respiratory failure, cardiovascular complications, long-term decline in lung function, and mortality. Several modifiable factors increase this risk, including active smoking, inadequate receipt of respiratory vaccinations, and inappropriate or prolonged use of inhaled corticosteroids (ICS) or proton-pump inhibitors (PPIs). OPTIMIZE Lung-HIV is a multicenter, patient-level randomized controlled hybrid Type 1 effectiveness-implementation trial evaluating whether a proactive, pharmacist-led E-consult intervention can improve evidence-based pulmonary pharmacotherapy for PWH. Pharmacists will review electronic health records, generate tailored recommendations, and pre-enter orders related to smoking cessation pharmacotherapy, vaccinations, and deprescribing of ICS or PPIs. Providers may enact or modify recommendations as clinically appropriate. The trial will assess the proportion of recommendations enacted within 3 months (primary outcome) and at 12 months (maintenance) and will use mixed methods guided by CFIR and RE-AIM to evaluate adoption, feasibility, acceptability, and implementation barriers and facilitators.

NCT Number	NCT07507435
Lead Sponsor	Seattle Institute for Biomedical and Clinical Research Collaborators: VA Puget Sound Health Care System, Minneapolis Veterans Affairs Medical Center, Boise VA Medical Center, West Haven VA Medical Center
Conditions	HIV, Inhaled Corticosteroid, Proton Pump Inhibitor, Smoking Cessation, Pneumonia
Enrollment	480 participants
Start Date	2026-08
Primary Completion	2029-03 (estimated)
Study Completion	2029-09 (estimated)
Updated on ClinicalTrials.gov	2026-07-07