Backgrounds: The burden of COVID-19 is more severe among elderly and patients who affected with chronic medical conditions like diabetes, cardiovascular diseases and HIV/AIDS. There are no studies regarding the level of HIV positive patients towards COVID-19 prevention, and their adherence to ART during the time of COVID-19 in Ethiopia.

Objective: To assess level of COVID-19 practices and HIV positive patient’s adherence to ART in nekemte public health facilities, Western Ethiopia, 2020.

Methods: Study was conducted in nekemte public health facilities, Western Ethiopia from August 15, 2020 to September 30, 2020. Facility based cross sectional study was employed among HIV positive patients on ART. A systematic random sampling technique was employed to select sample population. Face to face interview questionnaires was used during data collection.  A binary logistic regression models was fitted to identify associated factors dependent factors. An Odds ratio with their 95% confidence interval (CI) was used to determine the significance of predictors of poor adherence level. A P-value less than 0.05 were considered as a level of significance.

Results: A total of 361 HIV positive patients have participated in the study, yielding a response rate of 94%. The mean ± standard deviation (SD) age of participants was 33.8 ± 9.8 years. Overall, 89.2%, 53.7%, and 30.5% of respondents have good knowledge, positive attitude and good practice towards COVID-19 prevention, respectively. Seventy-seven (21.3%) of HIV positive patients had not adhered to ART follow-up. The study found low perceived risk towards COVID-19 (OR=3.74, 95% CI: 1.20, 11.58), poor practice towards COVID-19 prevention (OR=3.24, 95% CI: 1.55, 6.76), and substance use (OR=5.33, 95% CI: 1.61, 17.64), were independent predictors of poor adherence to ART.

Conclusion: Generally, non-adherent to ART among people living with HIV during the pandemic outbreak was high in the study area. Lower degree of perceived risk of coronavirus infection, poor practice of COVID-19 preventive measures and substance use were independent determinants of poor adherence to ART. Counselling for people living with HIV to improve their perception about the universal risk of coronavirus infection as well as on the preventive effect of compliance to public health measure should get due attention