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Dose Determination Trial for Evidence-Based Behavioral Counseling to Improve HIV Care Engagement and Treatment
Seth C Kalichman1, Moira O Kalichman, Julie Holt
1Institute for Collaboration on Health Intervention and Policy, University of Connecticut, CT.
Journal of Acquired Immune Deficiency Syndromes (1999)
|February 2, 2026
Summary
The minimally effective dose (MED) for behavioral counseling to improve HIV care, adherence, and viral suppression is 5 sessions. This dose varies between 4-6 sessions based on individual patient factors.
Area of Science:
- Public Health
- HIV/AIDS Research
- Behavioral Science
Background:
- Antiretroviral therapy (ART) benefits are limited by poor patient retention and adherence.
- Scaling evidence-based behavioral interventions requires understanding implementation details like optimal counseling dose.
- This study addresses the minimally effective dose (MED) of counseling and its patient-specific variations.
Purpose of the Study:
- Determine the MED of behavioral counseling for improving HIV care engagement, ART adherence, and viral suppression.
- Identify patient characteristics that moderate the dose-response relationship of counseling.
- Optimize the delivery of behavioral interventions for people living with HIV.
Main Methods:
- A dose determination trial involving 295 people living with HIV in the southeastern US.
- Participants were not engaged in care, non-adherent to ART, or had unsuppressed HIV.
- The study observed MED and moderators of dose over a 12-month period.
Main Results:
- 31% of participants dropped out after fewer than two counseling sessions.
- The MED for behavioral counseling was found to be 5 sessions.
- The MED ranged from 4-6 sessions, influenced by factors like social support and medication concerns.
Conclusions:
- Previous trials may have under-dosed (fewer than 5 sessions) or over-dosed (more than 6 sessions) behavioral counseling.
- Patient characteristics significantly moderate the dose-response relationship for behavioral counseling.
- Tailoring counseling dose based on individual patient needs is crucial for optimizing HIV treatment outcomes.
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