Nutritional status and its associated factors among adult People living with HIV: A Multi-facility level Study

Background: Malnutrition remains a major public health concern among adults living with HIV (PLHIV), yet evidence on its magnitude and its associated factors is limited in the study settings. Objective: To assess the nutritional status and associated factors among adults living with HIV. Methods: A multi-facility cross-sectional study was conducted across four hospitals and four health centers selected using a lottery method. A total sample of 927 adults on antiretroviral therapy (ART) was proportionally allocated based on currently on antiretroviral therapy (COA) case load. Data were collected through face-to-face interviews using systematic random sampling. Nutritional status was classified using Body Mass Index (BMI): underweight (<18.5 kg/m²), normal (18.5–24.9 kg/m²), and overweight (≥25 kg/m²). Analyses were performed using STATA version 17. Multinomial logistic regression identified predictors of nutritional status at a 95% confidence level with p < 0.05. Results: The prevalence of malnutrition was 43.75%, including 19.54% (95% CI: 16.98–22.11%) underweight and 24.21% (95% CI: 21.44–26.98%) overweight. Underweight was significantly associated with nutritional screening (ARR = 2.11, 95% CI: 1.35–3.31), secondary education (ARR = 2.95, 1.33–6.56), lack of fruit intake (ARR = 1.96, 1.26–3.04), physical inactivity (ARR = 2.12, 1.22–3.69), tobacco smoking (ARR = 3.32, 1.25–8.79), depression (ARR = 8.26, 3.16–21.60), skin infection (ARR = 1.79, 1.00–3.21), and low CD4 count (<200: ARR = 4.18, 1.56–11.16; 201–350: ARR = 1.94, 1.10–3.39). Reduced risk of underweight was observed among participants who were sons/daughters or homeless (ARR = 0.24, 0.09–0.59) and those who chewed khat (ARR = 0.19, 0.07–0.49). Overweight was less likely among participants with vocational/diploma education (ARR = 0.49, 0.24–0.99), middle wealth status (ARR = 0.44, 0.25–0.80), reduced appetite (ARR = 0.29, 0.13–0.66), ≥30 minutes of daily physical activity (ARR = 0.54, 0.35–0.83), and khat chewers (ARR = 0.25, 0.11–0.53). Overweight was more likely among those relying on a single food group (ARR = 2.64, 1.76–3.96), lacking fruit intake (ARR = 1.48, 1.00–2.19), smoking tobacco (ARR = 2.48, 1.09–5.65), and having a skin infection (ARR = 2.07, 1.25–3.44). Additionally, each one-unit increase in family size increased the risk of overweight by 24% (ARR = 1.24, 1.10–1.40). Conclusion: Malnutrition among PLHIV presents a dual burden of underweight and overweight influenced by socio-demographic, dietary, behavioral, and clinical factors. Strengthening routine nutritional screening, delivering targeted dietary counseling, promoting physical activity, addressing mental health concerns, and improving management of infections are essential to enhance treatment outcomes and quality of life for PLHIV.