Original Article Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study Aderajew Nigusse Tekelehaimanot, MPH 1 , Tefera Belachew Lemma, MD, MSC, PHD 1 , Esayas Kebede Gudina, MD, PhD 1 , Masrie Getnet, MsC 1 , Demuma Amdisa, MPH 1 , and Lelisa Sena Dadi, MPH/EP, PhD 1 Abstract Objectives: The study aimed to see predictors of undernourished and its implication towards HIV continuum care. Study Design: unmatched case-control study was conducted among 678 individuals in Jimma zone, southwest Ethiopia. Methods: Randomly selected data of 339 PLWHA who had poor nutritional outcomes (cases) and 339 without undernourished (controls) were analyzed. Logistic regression was used to identify forecasters of undernutrition. The quantitative results were supplemented from key informants who work closely on HIV care, then data were coded and analyzed thematically. Results: Rural residence (AOR:1.8; 95% CI: 1.2, 6.4), female (AOR: 2.9; 95% CI: 1.1, 4.3), unstable livelihood (AOR: 5.1; 95% CI: 4.2, 19.6), low meal frequency (AOR: 6.6; 95% CI: 5.2, 21.1), less diversified foods (AOR: 3.5; 95% CI: 1.2, 14.3), and advanced WHO clinical stage (AOR: 4.3; 95% CI: 3.6, 13.7) and were found to be independent predictors of undernourishment. No social support advanced clinical stage, and unstable livelihood adversely affect nutritional status of PLWHA from the qualitative data. Conclusions: The socio-cultural, economic, and health-system factors inhibit ideal patient nutritional status. Better tracking, enhanced livelihood and social support along with drug therapy, food aid needs to consider for PLWHA. Keywords adult, BMI, PLWHA, public hospitals, undernutrition Date received: 15 August 2020; revised: 21 October 2020; accepted: 02 November 2020. Introduction HIV prompted immune impairment and its occasioning oppor- tunistic infections (OIs) can diminution Appetite; intensifica- tion energy outflow; effect on malabsorption; and vary the body’s capability to operate and evacuate nutrients prominent to nutritional deficits and unfortunate overall nutritional sta- tus. 1 Nutritional shortfalls can, in turn, accelerate the move- ment of HIV infection and rise the hazard of emerging Ois. 2-6 In people with high HIV prevalence the adverse interactions between undernourished and HIV can influence health system of a nation. 7-9 Highly active Antiretroviral therapy (HAART) is believed to be a key to HIV allied degenerative. Nonexistence of diet, food insecurity, and the concern about diet has been shown to decrease treatment faithfulness. 10-16 Furthermore, starvation 1 Faculty of Public Health, Jimma University, Jimma, Ethiopia Corresponding Author: Aderajew Nigusse Teklehaimanot, Faculty of Public Health, Jimma University, Jimma, Ethiopia. Email: aderajewnu@gmail.com Journal of the International Association of Providers of AIDS Care Volume 19: 1-9 ª The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2325958220976254 journals.sagepub.com/home/jia Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).