<p>Clinical measurements protocol.</p>

Adolescents living with HIV (ALHIV) in Ethiopia face significant nutritional challenges due to increased energy requirements, HIV-related complications, and socioeconomic constraints. This study assessed the nutritional status of ALHIV, examined associated factors, and evaluated gaps in the provision of nutritional care within antiretroviral therapy (ART) clinics. Two cross-sectional surveys were conducted in ten public hospitals across Addis Ababa and Oromia, involving 384 ALHIV aged 10–19 years and 44 healthcare professionals. ALHIV were selected through proportionate random sampling, while healthcare workers were purposively recruited. Data were collected using a pre-tested, structured questionnaire with both quantitative and qualitative components, administered by trained staff via the Kobo-Toolbox. Quantitative data were analyzed using descriptive statistics and logistic regression, while qualitative responses were analyzed using thematic analysis. The study included adolescents with a mean age of 15.9 years, of whom 54% were female. Overall, 24.2% of ALHIV were thin, 21.7% were stunted, and 34.9% were malnourished, including 19.4% with severe acute malnutrition. Food insecurity was a key factor negatively affecting nutrition and ART adherence. Although routine anthropometric assessments were commonly performed, only 36.4% of healthcare providers assessed dietary intake, 27.3% evaluated food security, and 38.6% provided regular nutrition counseling. Healthcare providers reported barriers including limited training, heavy workload, and resource constraints. Malnutrition remains a significant concern among ALHIV in Ethiopia, while several components of recommended nutritional care are inconsistently implemented in ART clinics. Strengthening the integration of comprehensive nutrition services, including routine dietary assessment, nutrition counseling, and food security screening, into ART care programs may improve the health and treatment outcomes of ALHIV.