Background Viral load suppression among people living with HIV is the main goal of antiretroviral therapy (ART). The most cause for high viral load is poor adherence to ART. World Health Organization (WHO) recommends intensive enhanced adherence counseling for people with a high viral load, which is greater or equal to 1000 RNA copies per mL and at least on treatment for six months. However, little is known about the outcome of enhanced adherence counseling. The study aimed to assess the incidence of viral load suppression after enhanced adherence counseling and its predictors among HIV-positive adults in high caseload health facilities in the Amhara region, Ethiopia. Methods An institution-based retrospective follow-up study was employed among 346 HIV-positive adults enrolled in enhanced adherence counseling in a high caseload health facility in the West Gojjam zone from June 2016 to June 2020. The data on relevant variables were collected from the patient’s medical cards by trained data collectors. The collected data were entered into EpiData version 3.1 and then exported to Stata version 14 for analysis. Descriptive analysis was performed to describe the variables. Cox proportional regression model was used to identify independent predictors of viral load suppression after enhanced adherence counseling. Results Overall, 51.73% of the study participants achieved viral load suppression after enhanced adherence counseling. The incidence of viral load suppression rate was 11.17 per 100-person month. During the multivariate analysis, it was observed that being female (AHR = 1.50, 95% CI: 1.05–2.15), CD4 count of greater than or equal to 350 cells/mm 3 (AHR = 1.98, 95% CI: 1.12–3.51) and no recurrent OI (AHR = 1.85, 95% CI: 1.06–3.24) were an independent predictor of viral load suppression after enhanced adherence counseling. Conclusion Incidence of viral load suppression rate was still far from the WHO target (70%). Therefore, higher priority should be given to patients with low CD4 counts with improved enhanced management of opportunistic infections.