This pilot study investigates the feasibility and effect of an intervention based on coaching and directly observed therapy (DOT), aimed at patients who are HIV-positive and have massive adherence problems and treatment failure. Participants were followed six months with coaching, homework and DOT. Eleven were enrolled and seven completed at least six sessions. All seven were satisfied with the intervention. DOT was not usable; six of the seven had more than half of their viral load counts below 500 copies/ml one year after the intervention. Only two of the seven had so before the intervention.