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Background Orphan and vulnerable children (OVC) are at a heightened risk of poor health outcomes, particularly in areas with a high prevalence of HIV/AIDS. Viral load (VL) testing is a vital component of HIV care that enables early detection of treatment failure and improves health outcomes. During the first half of the US Agency for International Development Family Focused HIV Prevention, Care and Treatment activity implementation (October 2023–March 2024), OVC VL testing coverage in Jinka town was 89%. This shortfall affects the timely diagnosis and treatment adjustments for OVC, posing a challenge in achieving the third 95% HIV target. This quality improvement (QI) project aims to improve VL testing coverage among OVC in Jinka town.Method A multidisciplinary QI team used the fishbone diagram to identify the root causes of low VL testing coverage. The nationally adopted model for improvement was employed using the plan–do–study–act (PDSA) cycles. Baseline data were taken from January to March 2024. The QI project was implemented from 1 April to 30 September 2024, for 6 months. A run chart was used to track the progress of the QI project and enforce evidence-based decision-making.Interventions The QI team tailored five well-worked interventions tested in three PDSA cycles, including appointment date reminders for OVC caregivers, on-the-job capacity building and targeted supportive supervision for staff, conducting caregiver awareness sessions, weekly VL result tracking and feedback mechanism and enhancing community–facility linkages.Results The run chart demonstrated a 7% increment in OVC VL testing coverage, evidenced by six consecutive data points above the median line, indicating a statistically significant association between the identified QI gap and the implemented interventions.Conclusion The QI project effectively improved the OVC VL testing coverage in Jinka town. This collaboration not only improves the VL testing coverage but also provides a comprehensive supportive environment for caregivers and families affected by HIV in the area.