Basic demographic and clinical characteristics.

People living with HIV (PLHIV) who do not achieve viral suppression on antiretroviral therapy contribute to HIV transmission. Poor adherence is a major factor associated with high viral load (VL). Enhanced adherence counseling (EAC) is a targeted intervention to improve adherence and achieve viral suppression, but data on post-EAC outcomes in Zambia remain limited. This study assessed viral suppression and associated factors among PLHIV with unsuppressed VL after completion of EAC at University Teaching Hospital and Kanyama First-Level Hospital. This retrospective cohort study analyzed VL register data from 1st January 2021–31st December 2023. Baseline demographic, clinical, and laboratory data were collected, with follow-up VL measurements at three and 12 months post-EAC. The primary outcome was viral suppression at three months, defined as a VL