Undernutrition and Associated Factors Among Adults on Second-Line Antiretroviral Therapy in Debark, Ethiopia: A Cross-Sectional Study.

Background/ObjectivesUndernutrition remains a major public health challenge among people living with HIV, particularly in low-income settings, where it adversely affects treatment outcomes, immunity, and survival, where it contributes to poor treatment outcomes, increased susceptibility to opportunistic infections, and higher mortality. Although several studies in Ethiopia have examined undernutrition among adults receiving first-line antiretroviral therapy (ART), evidence focusing specifically on individuals receiving second-line ART is limited. Therefore, this study aimed to assess the prevalence of undernutrition and identify factors associated with undernutrition among adults living with HIV receiving second-line ART in public health facilities of Debark town, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from June 1 to June 30, 2025, among adults living with HIV receiving second-line ART in public health facilities of Debark town, Ethiopia. Participants were selected using a simple random sampling technique based on medical registration numbers. Data were collected using a structured interviewer-administered questionnaire and medical record review checklist adapted from previous studies. Nutritional status was assessed using body mass index (BMI). Data were entered into EpiData version 3.1 and analyzed using STATA version 14. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with undernutrition.ResultsUndernutrition, defined as a BMI of < 18.5 kg/m2, was observed in 24% of the participants (95% confidence interval (CI) [20-28]). Factors significantly associated with undernutrition included poor ART adherence (adjusted odds ratio (AOR) = 4.10; 95% CI [1.64-10.27]), ART duration ≤24 months (AOR = 9.20; 95% CI [3.43-24.65]), presence of opportunistic infections (AOR = 2.35; 95% CI [1.11-4.96]), low dietary diversity score (AOR = 2.19; 95% CI [1.19-4.04]), moderate household food insecurity (AOR = 2.17; 95% CI [1.16-4.09]), and severe household food insecurity (AOR = 2.53; 95% CI [1.17-5.46]).Conclusion and recommendationsThe prevalence of undernutrition among adults receiving second-line ART was high. Poor treatment adherence, opportunistic infections, shorter duration of therapy, household food insecurity, and low dietary diversity were significantly associated with undernutrition. Strengthening nutritional counseling, promoting dietary diversification, linking food-insecure households to food support and social protection programs, and integrating routine nutritional assessment and support into HIV care are recommended to improve nutritional outcomes in this population.