{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:08:23Z","timestamp":1788433703454,"version":"build-2803163510"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    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 1\n                    <jats:sup>st<\/jats:sup>\n                    January 2021\u201331\n                    <jats:sup>st<\/jats:sup>\n                    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\u2009&lt;\u2009200 copies\/mL. Poisson regression with robust standard errors identified factors associated with suppression. Among 386 participants (median age 39 years, IQR: 31\u201347), 52.9% were female. The baseline VL was 21,600 copies\/mL (IQR: 3,692\u2013106,000). At three months post-EAC, 85% (330\/386) achieved viral suppression, with 95.8% (316\/330) maintaining suppression at 12 months. Viral rebound occurred in 4.2% (14\/330). EAC delivered through both telephone and in-person methods increased suppression likelihood by 15% compared to those who received EAC in-person (physical) alone. Prior enrollment in six-month multi-month dispensing (MMD) was associated with a 23% increased likelihood of suppression compared to those who had never received MMD. Participants on tenofovir\/lamivudine\/dolutegravir were 29% more likely to suppress compared to those on zidovudine\/lamivudine\/dolutegravir. EAC modestly improves and sustains viral suppression among PLHIV with high viral loads. In-person and telephone-based EAC improved viral suppression by 15% compared to in-person alone. Other key factors influencing suppression were community-based delivery and prior six-month MMD. Findings highlight opportunities to integrate technology-enhanced adherence support and differentiated service delivery models to optimize HIV care outcomes.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0005417","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T18:31:37Z","timestamp":1762367497000},"page":"e0005417","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Viral suppression and associated factors after enhanced adherence counseling among people living with HIV with unsuppressed viral loads at tertiary and first-level health facilities in Zambia: A retrospective cohort study"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1186-5045","authenticated-orcid":true,"given":"Chitalu","family":"Chanda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Webster 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