Self-management support for people living with chronic diseases, such as hypertension, can improve treatment outcomes. However, to effectively provide self-management support, nurses must possess adequate knowledge, demonstrate self-efficacy, and actively engage in it. The study aimed to examine nurses’ knowledge, self-efficacy, and performance of hypertension self-management support and the relationships among these variables and socio-demographic characteristics in the northern region of Ghana. An analytic cross-sectional study was conducted among 266 nurses in three hospitals in the Northern Region of Ghana. Respondents completed self-reported questionnaires from two validated instruments (one was adopted wholly, and the other was modified), measuring hypertension self-management knowledge, self-efficacy, and performance of self-management support. The data were processed using the IBM Statistical Package for Social Sciences version 30. Respondents had a mean knowledge score of 56.2 ± 11.74

Background:Climate change increasingly affects global health, with low- and middle-income countries (LMICs) facing recurrent droughts, heatwaves, and extreme weather events that strain primary health care (PHC) systems. Nurses, as frontline providers, are critical for managing climate-sensitive conditions and promoting resilience. Evidence on nurses' climate-health engagement in LMICs remains limited. Objective:To assess awareness, motivation, and behaviours related to climate change among primary health care (PHC) nurses in the Western Cape, South Africa, using a contextualised Climate, Health, and Nursing Tool (CHANT). Methods:A descriptive cross-sectional survey was conducted in 38 PHC facilities. An all-inclusive sampling approach yielded 128 professional nurses. Data were collected via a self-administered questionnaire adapted for local context. Descriptive statistics and non-parametric tests were applied. Results:Most respondents (76.2%) were aware of climate change, primarily through television (75%) and social media (60.9%). Two-thirds (66.7%) had experienced extreme weather events, and 74.6% had managed climate-sensitive conditions, notably respiratory illnesses. Concern and motivation were high (90%), and 70% believed mitigation is possible; however, 51.6% perceived the issue as complex, and 25% felt overwhelmed. Climate-friendly behaviours were more frequent at home (15-77%) than at work (12-45%), and only 9% engaged in climate communication with policymakers. Conclusion:Despite strong concern and motivation, workplace climate actions remain limited. Strengthening nurses' sustainability knowledge and institutional support is essential for advancing climate-resilient PHC systems.

IntroductionAdolescents living with HIV (ALHIV) face unique psychosocial and structural challenges affecting ART adherence and engagement in care. Despite Zambia's expansion of adolescent-friendly HIV services, adolescents continue to experience poorer adherence and treatment outcomes than adults, including lower viral suppression and retention in care and limited understanding remains around the experiences of ALHIV and their caregivers. This study explored multilevel factors influencing ART adherence in Lusaka district from the perspectives of ALHIV and their caregivers.MethodsWe conducted an exploratory qualitative study on psychosocial, behavioral, and structural factors influencing ART adherence and experiences of HIV services among ALHIV in Lusaka, Zambia. Between February and July 2025, 35 in-depth interviews (20 ALHIV who were already aware of their HIV status and engaged in long-term care and 15 caregivers) were conducted across six health facilities (four PHC and two first-level facilities). Interviews were held in English or Nyanja, audio-recorded, transcribed, and analyzed using ATLAS.ti v24. A hybrid inductive-deductive approach, informed by the socioecological model, guided coding. Themes were organized in an analytical matrix showing multilevel influences on adherence, including emotional burden, stigma, support systems, and structural barriers. Trustworthiness was ensured through triangulation, peer debriefing, and iterative codebook development.ResultsThe themes identified spanned intrapersonal (individual), interpersonal, organizational/institutional, community, and structural/policy-level factors influencing ART adherence, alongside participant-generated cross-cutting recommendations to strengthen adolescent HIV service delivery. Many adolescents struggled with stigma, emotional distress, and challenges of consistent medication adherence, while others adapted through acceptance, spirituality, and counseling. Supportive relationships with family, peers, and healthcare workers fostered adherence, but stigma, school challenges, inconsistent caregiving, and limited privacy remained significant barriers. Socioeconomic issues, such as transport costs, hindered treatment continuity. Helpful strategies included routine-building, reminders, and increased health literacy. Participants recommended improving adolescent-friendly services by integrating mental health support, strengthening provider communication, expanding peer networks, and reactivating support groups to better support ART adherence among ALHIV.ConclusionAddressing psychological, social, service delivery, and structural barriers such as coordination between schools and the health system is vital to improving ART adherence among ALHIV in Zambia. A multilevel approach is needed to support sustainable treatment outcomes.

Midwives are uniquely positioned to implement health literacy programmes, yet there is limited synthesis of existing midwife-led health literacy programmes for pregnant women in Africa. This scoping review maps the evidence on health literacy programmes to improve the self-care of pregnant women in Africa. Eight articles, published between 2015 and 2025, were included across African countries from six electronic databases, such as MEDLINE and one search engine: Google Scholar. Maternal health literacy programmes varied in mode of delivery, duration, components, and outcomes. Most programmes used a group antenatal care model, a combination of face-to-face and digital health tools, and focused on improving functional, interactive, and critical health literacy. Maternal health literacy programmes in African countries seem to be under-researched. More research is needed to strengthen the outcomes of programmes such as usability and acceptability, knowledge and awareness, and clinical outcomes. In addition, longer-term research is necessary to assess the implementation and sustained impact of these programmes.

Objective:This mixed-method systematic review aimed to synthesize quantitative and qualitative ev-idence on the effectiveness of nurse-led self-management interventions for people with hypertension. Methods:This review,guided by the Joanna Briggs Institute(JBI)manual for evidence synthesis,was conducted by searching PubMed,CINAHL,Web of Science,Scopus,Google Scholar,and reference lists of included studies.Two reviewers independently screened,critically appraised,and extracted data from studies reporting nurse-led interventions for hypertension self-management.The JBI critical appraisal tool for randomized control trials and the mixed methods appraisal tool were used to appraise included studies.Meta-analysis was performed using Review Manager 5.4.1.The certainty of the evidence was determined using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)system. Results:A total of 22 studies and 2,706 participants were included.Most studies were conducted in Asia,with only one study from Africa.Most interventions employed a hybrid of face-to-face and mHealth and were delivered through a blend of individual and group-based approaches.The meta-analysis showed that nurse-led self-management interventions significantly reduced systolic blood pressure(MD=-7.60;95％CI:-9.83,-5.36;P ≤ 0.001;18 studies)and diastolic blood pressure(MD=-4.12;95％CI:-5.83,-2.41;P ≤ 0.001;18 studies)compared to usual care in hypertension management.The qualitative evidence revealed that peer support through shared experience enhanced self-management. Conclusions:Nurse-led interventions focusing on self-management are effective for improving hyper-tension outcomes compared with usual care.Still,the high heterogeneity suggests that factors such as population characteristics and intervention components may influence effectiveness.A combination of individual and group-based approaches offers dual benefits:tailored care and patient peer support through shared experiences.

Background: Hypertension is the main risk factor for cardiovascular-related morbidities and mortalities. Nurses play a pivotal role in hypertension care, encompassing screening, detection, management, patient education and self-management counselling. Aim: This study assessed nurses’ knowledge of hypertension care and associated factors in the Northern Region of Ghana. Setting: Tamale Metropolis of the Northern Region of Ghana. Methods: A descriptive cross-sectional study was conducted among nurses. Using a census approach, 410 eligible nurses working in hypertension care across the study hospitals were invited to participate. Of these, 266 consented and completed a self-reported validated questionnaire. The IBM Statistical Package for the Social Sciences programme version 30 was used to process the data and perform descriptive and inferential statistics. Results: The mean hypertension care knowledge score was 51.47% ± 11.76%. About 4% had good knowledge, 57.1% average knowledge, and 38.7% had poor knowledge. While nurses demonstrated good knowledge of accurate blood pressure measurement (82.4%), their knowledge of hypertension diagnosis (35.1%) and management (48.8%) was poor. The following were significantly associated with overall knowledge of hypertension care: hospital of practice (p = 0.021), age (p = 0.007), nursing category (p = 0.002), qualification (p = 0.001), years of practice in the present unit (p = 0.021) and hypertension in-service training (p = 0.027). Conclusion: This study revealed significant gaps in nurses’ knowledge of hypertension care and highlighted the need for continuous professional development to bridge knowledge gaps and sustain clinical competence. Contribution: The study provided evidence on nurses’ knowledge of hypertension care in Ghana, which can inform the development of tailored interventions to improve management and patient outcomes.

Background:The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, posing risks for adolescents living with HIV (ALHIV) in resource-limited, high HIV-prevalence settings. These disruptions threatened antiretroviral therapy (ART) adherence, viral load suppression (VLS) and retention in care (RiC). Aim:This study aimed to compare treatment outcomes of ALHIV on ART in the Khayelitsha and Eastern Substructure (KESS) before and during the COVID-19 pandemic. Setting:The study was performed in KESS, Cape Town, South Africa. Methods:A retrospective cohort analysis was conducted among ALHIV aged 10-19 years receiving ART at public health facilities, pre-COVID-19 (before 01 March 2020) and during COVID-19 (01 March 2020-31 December 2021). Sociodemographic, clinical, and treatment data were analysed. Descriptive and inferential statistics compared outcomes and determined factors associated with VLS (< 1000 copies/mL) using SPSS v.30. Results:Data from 1702 ALHIV (pre-COVID-19) and 2733 ALHIV (during COVID-19) were analysed. Viral load suppression declined from 82.1% to 64.8%, while full VLS (< 50 copies/mL) from 70.8% to 53.7% (p = 0.065). Antiretroviral therapy adherence fell from 96.4% to 70.0% (p < 0.001), and RiC 80.3% to 76.3% (p < 0.001). In multivariate analysis, higher CD4 count, and consistent ART adherence predicted VLS. Conclusion:Antiretroviral therapy adherence and VLS rates among ALHIV declined during COVID-19. Adolescent-centred healthcare delivery models are needed to ensure continuity of HIV treatment during public health emergencies. Contribution:This study provides local evidence on the pandemic's impact in a high-burden South African context. By quantifying declines in ART adherence, RiC, and VLS, it highlights ALHIV vulnerabilities and the need to strengthen adolescent-responsive, resilient healthcare systems.

Background: Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care. Aim: This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District. Setting: The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents. Methods: A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery. Conclusion: Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia’s progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade. Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.

Background: With the increasing burden of non-communicable chronic diseases, it is important to empower people to self-manage their conditions. This study aimed to explore the support that persons living with chronic disease require to self-manage their conditions at a Primary Health Care (PHC) facility in the Victor-Khanye subdistrict, Delmas, Mpumalanga. Methods: Individual in-depth interviews were conducted with 14 adult participants who collected their monthly medication for diabetes, human immunodeficiency virus or hypertension. Data were analysed manually using thematic analysis. Results: Three themes were identified: (1) individual self-management; (2) support enhancing for self-management; and (3) barriers to self-management. The study highlights that self-management requires a combination of individual beliefs, capabilities, education, access to healthcare resources, financial assistance, emotional support from family and friends, and community support. While knowledge is crucial for empowering individuals to manage their diseases effectively, challenges such as financial constraints and a lack of specific self-management support provided by healthcare workers hinder many from fully implementing self-management strategies. Conclusion: Persons living with chronic disease require comprehensive care that extends beyond healthcare and includes emotional, social and financial support. Effective self-management requires access to tailored education and community support networks that allow people to take an active role in their health. Contribution: Understanding the support persons living with chronic diseases require for effective self-management is critical for improving health outcomes, enhancing quality of life and promoting sustainable healthcare systems.

Background: Maternal health knowledge enables pregnant women to access, understand and apply health information to support maternal and foetal well-being, while inadequate knowledge may impair caregiving and lead to adverse pregnancy outcomes. Aim: This study aimed to assess maternal health knowledge and identify associated factors among pregnant women attending antenatal clinics in the Western Cape. Setting: The study was conducted in three antenatal clinics in the Western Cape, South Africa. Methods: A descriptive survey was conducted from August 2022 to November 2022 among 248 pregnant women using a researcher-administered questionnaire incorporating the validated 21-item Maternal Health Literacy Inventory in Pregnancy scale. Data were analysed using Statistical Package for Social Sciences (SPSS) version 29. Descriptive statistics and the Mann–Whitney test were employed to examine the associations between demographic characteristics and maternal health knowledge. Results: Respondents demonstrated low to moderate maternal health knowledge (mean = 58.50/100, standard deviation [s.d.] = 13.79, with over half (51.2%, 95% confidence interval [CI]: 45.0–57.4) classified as having problematic levels of maternal health knowledge. The highest ratings for knowledge were for foetal well-being (mean = 3.33, s.d. = 0.65) and lowest for postnatal care (mean = 3.26, s.d. = 1.17). Higher knowledge score was significantly associated with secondary or higher education (χ2 = 3.570, p 0.001) and living with others (χ2 = 4.568, p = 0.028). Conclusion: Maternal health knowledge was inadequate, highlighting the need for strengthened and targeted maternal health education, especially for less-educated women and those living alone. Contribution: The study provides evidence to guide healthcare practitioners and programme planners in improving maternal health education in antenatal clinics in the Western Cape.

The terms chronic health conditions and long-term health conditions are often used interchangeably, yet they carry distinct conceptual emphases. Chronic health conditions typically prioritise ongoing medical management reflecting a predominantly biomedical and adult-centred care logic. In contrast, long-term health conditions foreground the enduring consequences of illness for an individual’s development and wellbeing across the life course. This debate examines the implications of these terms, particularly for adolescent health, arguing that persistent reliance on adult-centred biomedical framings obscures developmental, relational and contextual dimensions of care. Intentional reframing of terminology in policy, research and practice can support adolescent-centred, developmentally appropriate approaches that extend beyond disease control to encompass physical, psychological and social wellbeing. Such a shift has implications for the design of interventions, service delivery and policy frameworks, enabling healthcare systems to better support adolescents’ needs and their transition to adulthood. While adolescence provides a critical lens, this reframing holds relevance across the life course by strengthening person-centred approaches to care.

BACKGROUND:Implementing HIV policy involves translating policy goals into practical action. In the Western Cape, South Africa, the lack of clear guidelines has challenged the consistent implementation of HIV policies at primary healthcare (PHC) facilities. OBJECTIVES:This study aimed to explore HIV managers' experiences regarding the challenges of HIV policy implementation at PHC facilities within the Northern Tygerberg sub-district, Cape Metropole, Western Cape. METHOD:An exploratory, descriptive, qualitative design was employed. Purposive sampling was applied to select HIV managers (n = 10) with experience in policy implementation. Data were collected through semi-structured interviews and analysed using thematic analysis. RESULTS:Four themes emerged from the study, reflecting the challenges experienced by HIV managers during the implementation of HIV policies at PHC facilities, including human resource challenges, staff knowledge and attitudes, system readiness, and training. CONCLUSION:Effective implementation of HIV policy remains essential to the national HIV response. While significant targets have been achieved, ongoing systemic challenges continue to hinder optimal policy execution and the delivery of services.Contribution: The study highlights the critical need for stronger human resource systems, improved training platforms, and enhanced facility infrastructure to ensure effective HIV policy implementation and better health outcomes for individuals living with HIV.

Adolescents and youth living with HIV (AYLHIV) face increased health risks and need targeted support to optimally engage in treatment. The Supporting Adolescents to be Resilient and Thrive (S-SMART) programme is a digitally enabled, peer-supported self-management intervention designed to enhance psychosocial and treatment engagement outcomes among AYLHIV. This pilot study evaluated the feasibility and acceptability of S-SMART among AYLHIV aged 15-21 years who received HIV treatment at two public primary care clinics in the Cape Town Metropole, South Africa. Thirteen AYLHIV received smartphones, mobile data, and access to the S-SMART app from September to December 2024. The pilot programme for S-SMART included activities, peer group sessions, and coaching by four peers living with HIV. Focus groups were conducted before (n = 17) and after (n = 12), to assess usability and their user experiences. Activity and programme completion was > 95%. Participants found the app user-friendly overall, though some faced issues with navigation, language and understanding certain content. Engagement was strengthened through peer support and facilitation. While the programme promoted psychosocial empowerment, HIV-related challenges such as stigma and disclosure fears need ongoing support.

Background: Maternal health literacy influences how pregnant women access, understand and use healthcare services for themselves and their children. Limited maternal health literacy is associated with poor maternal and foetal outcomes. Aim: To assess maternal health literacy and its associated factors among pregnant women attending antenatal clinics in the Western Cape. Setting: The study was conducted in antenatal clinics of the Western Cape. Methods: A cross-sectional survey was conducted among 248 pregnant women using the Maternal Health Literacy Inventory in Pregnancy (MHELIP), together with measures of socio-demographics, depression and functional health literacy (reading and understanding). Data were analysed using the Statistical Package for Social Sciences (SPSS) version 29. Descriptive statistics summarised participant characteristics and maternal health literacy domains, while non-parametric tests and logistic regression identified predictors of maternal health literacy. Results: Participants had a mean age of 27.4 years (± 7.53; range: 18-45), and 60.5% (n = 150) reported more than two pregnancies. Most respondents (80.0%, n = 196) had limited maternal health literacy, with a mean MHELIP score of 57.8 out of 100 (standard deviation [s.d.]: 10.8; range: 21–87). Adequate maternal health literacy was significantly associated with higher reading, understanding, and decision-making scores, while women with no risk of depression scored higher in assessing maternal health information (p < 0.05). Reading and understanding significantly predicted maternal health literacy (odds ratio [OR]: 1.20), explaining 10.0% of the variance. Conclusion: Most pregnant women had limited maternal health literacy, underscoring the need for tailored antenatal education. Contribution: The findings inform the development of maternal health literacy programmes to support informed decision-making among pregnant women in South Africa.

Background: Oral health conditions are preventable, but frequently neglected because of limited knowledge, negative attitudes, and misconceptions within communities. Aim: This study aimed to determine the oral health knowledge, attitudes, and practices and factors associated with these outcomes and self-reported oral pain among community members across four communities (two urban and two semi-rural) in the Western Cape, South Africa. Setting: Two urban and two semi-rural communities in the Western Cape, South Africa. Methods: A cross-sectional survey using a researcher-administered questionnaire with validated instruments (The World Health Organization [WHO] Oral Health Assessment and the Rustvold Scale) was conducted among 776 adults, with knowledge, attitudes, and practices measured using composite scores. Data were analysed using descriptive and multivariable analyses to identify socio-demographic factors associated with knowledge, attitudes, and practices, as well as factors associated with self-reported oral pain. Results: Most respondents were female (n = 567, 73.1%) with a mean age of 42.3 ± 14.2 years. Overall knowledge was moderate (mean score: 68.4%, 6.84, ± 1.4). While most respondents reported daily toothbrushing and using fluoride toothpaste, only 13.8% used dental floss, and fewer than 20% had visited a dentist in the past year, primarily for pain. In multivariable logistic regression analysis, semi-rural residence (adjusted odds ratio [aOR]: 2.1; 95% confidence interval [CI]: 1.4–3.1), female gender (aOR: 1.6; 95% CI: 1.2–2.3), and poor self-reported health status aOR: 1.8; 95% CI: 1.2–2.7 were associated with higher odds of self-reported oral pain. Conclusion: Despite moderate knowledge and positive attitudes, gaps in oral health practices persist, with higher odds of oral pain among semi-rural residents and those with poorer health. Contribution: Findings support targeted oral health promotion and improved access to preventive care in semi-rural communities.

Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises.

Successful transition from paediatric to adult HIV care programme is a critical developmental milestone in the care trajectory of adolescents living with HIV (ALHIV). The transition process involves a shift from a structured, caregiver-supported healthcare model to one that requires independence and self-management. This process should be guided and supportive to ensure continued engagement in care and optimal adherence when ALHIV are transferred. This study utilised photovoice methods to explore the transition experiences of ALHIV in the Cape Town Metropole. Audio-recorded focus group data were transcribed verbatim and subjected to reflexive thematic analysis. Three distinctive patterns of behaviour from ALHIV were identified as themes. Type 1: socially reliant, dependent adolescent who heavily relies on family and peer support and struggles with adherence. Type 2: socially disconnected, hyper-independent adolescent , who is self-reliant, seeks solitude, and is generally resistant to external support. We configured a third (ideal) type, who is interdependent and able to self-manage their chronic condition, but within a supportive health care environment that provides positive healthcare and transition experiences. The findings underscore the need for supportive transition models promoting self-management skills, while facilitating a symbiotic relation with healthcare staff promoting sustained engagement in care well into adulthood. We recommend that adolescent or youth friendly services for ALHIV be expanded to support and monitor the transition process and outcomes in the adult HIV program.

Background: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10–19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15–24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018. Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10–19 years) on ART in Lusaka District, Zambia. Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29. Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate ( 1000 copies/mL), with 79% fully suppressed ( 50 copies/mL). In multivariate analysis, older adolescents (15–19 years) had lower odds of suppression compared to younger adolescents (10–14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI] : 1.32–2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23–8.11) and optimal adherence (AOR = 1.89; CI: 1.03–3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45–0.80). Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents.