Background Adolescence is a crucial period for growth, and adequate nutrition is essential for those living with HIV/AIDS and on antiretroviral therapy (ART). Despite declining HIV prevalence in Ethiopia, adolescents continue to face challenges that negatively impact their nutritional status. This study explored clinical, lifestyle, environmental, and dietary factors influencing the nutrition of adolescents on ART in selected Ethiopian hospitals.

Method Cross-sectional surveys, clinical assessments and clinical record reviews were conducted, recruiting 384 ALHIV in receipt of ART at ten public hospitals in Addis Ababa and Oromia regions in August – December 2023. Participants were selected using proportionate random sampling for ALHIV and data were collected using a pre-tested interviewer-administered structured questionnaire and standardised assessments by trained healthcare workers.

Results Nutritional assessments revealed 24.2% of participants classified as thin, 21.7% as stunted, and 34.9% as acutely malnourished. Factors significantly determinant of malnutrition included, for thinness, male gender, household food insecurity, a history of chronic infections such as tuberculosis, and symptom levels indicative of anxiety and moderate/moderately severe depression. Significant factors for acute malnutrition included younger rather than older adolescence (aged 10–17), male gender, larger household size (four or more members), household food insecurity, delayed disclosure of HIV status, history of chronic infections, generalized anxiety disorder, and low haemoglobin levels (<11 mg/dL).

Conclusion and Recommendations Findings highlight the multifaceted challenges faced by ALHIV, inform and underscore the need for targeted nutritional and mental health interventions to address the specific challenges faced by this vulnerable group.

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.

Yes

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.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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MGB: natanmelessgmail.com or MelessGebrie.Borestudent.uts.edu.au, LP: lin.perryuts.edu.au, XX: luna.xuunsw.edu.au, AKB: andargachewkahu.edu.et, MC: Marilyn.Cruickshankuts.edu.au

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.