Background Adolescents living with HIV (ALHIV) in Ethiopia face significant nutritional challenges affecting their health and ART outcomes. Increased energy needs, HIV complications, and socioeconomic barriers contribute to their vulnerability. Despite ART advancements, research on their nutritional care remains limited, and comprehensive guidance is lacking. This study assessed ALHIV’s nutritional status, nutrition support in ART clinics, and strategies for improvement.

Method A two cross-sectional survey were conducted in ten public hospitals across Addis Ababa and Oromia regions, involving 384 ALHIV and 44 healthcare professionals. Healthcare workers were selected through purposive sampling, while ALHIV were recruited using proportionate random sampling. Data was collected using a pre-tested structured questionnaire with quantitative and qualitative components, administered by trained healthcare workers via the Kobo Toolbox program.

Results Nutritional assessments of ALHIV revealed that 24.2% were thin, 21.7% were stunted, and 34.9% were malnourished based on mid-upper arm circumference, with 19.4% experiencing severe acute malnutrition. Many adolescents faced food insecurity, which negatively affected their nutritional status and ART adherence.

While most healthcare workers conducted basic nutritional assessments, the use of sensitive tools was limited. Only 36.4% assessed dietary intake, 27.3% evaluated food security, and 38.6% provided regular nutrition counseling. Healthcare professionals expressed dissatisfaction with the integration of nutrition services due to inadequate training and resource constraints.

Conclusion The study highlights significant gaps in nutrition support and malnutrition among ALHIV on ART in Ethiopia. Integrating nutritional assessments and counseling into routine ART care, enhancing healthcare worker training, and developing standardized nutritional guidelines are essential for improving outcomes. Addressing food insecurity and socioeconomic barriers through adequate resources and policies is also critical for better health outcomes. Further research is needed to understand the long-term nutritional needs of ALHIV.

The authors have declared no competing interest.

The authors received no specific funding for this work. It is part of a PhD thesis by MGB. MGB was a higher degree research candidate at UTS, supported by the International Research Training Program (IRTP). The IRTP is a commonwealth scholarship funded by the Australian government and the Department of Education and Training.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Human Research Ethics Committee at the University of Technology Sydney, Australia (Ref. Number: ETH23-7873) the Institutional Review Board of the College of Medicine and Health Sciences, Hawassa University, Ethiopia (Ref. Number: IRB/321/15) — which also covered the Oromia region study sites the Addis Ababa City Administration Health Bureau Ethics Review Committee, Ethiopia (Ref No: A/A/3/54/227) and St. Paul‘s Hospital Millennium Medical College Institutional Review Board (Ref No: PM23/181). Permission was secured from all health institutions involved in the study. Written informed consent for participation was obtained from participants‘legal guardians or next of kin. Confidentiality was assured and maintained throughout the study

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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The data supporting the findings of this study are available upon reasonable request. Access to the data may be restricted to ensure participant confidentiality and to comply with ethical guidelines.