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Background: Substantial progress has been made in themanagement of pediatric HIV infection in Ethiopia with theimplementation of mother-to-child-prevention programs. Since theintroduction of HAART in 2005, mortality among HIV-infectedchildren has reduced while the rate of hospitalization was expectedto rise. The purpose of this study, therefore, was to assesspredictors of hospitalization in children on ART in seven universityreferral hospitals in Ethiopia.Methods: A prospective cohort study design was employed onchildren age 0-18 years as part of a multisite observational study.ART-experienced eligible and ART-naïve children with HIV/AIDSwere enrolled into the Advanced Clinical Monitoring (ACM) tillDecember 31, 2012 were included. From the database, informationon hospitalization and other independent variables were extracted.Analysis was done using both SPSS for Windows version 16.0 andSTATA. Descriptive analyses and modeling was done using logisticregression.Results: Of the 405 children on ART (174 experienced, 231 naive),86 (20.7%) were hospitalized for various reasons; two childrenwere excluded since they were hospitalized for unrelated conditions(appendicitis and burn). Fifty one (60.7%) of the eighty fouradmitted children were hospitalized in the first six months of ARTinitiation. Of the independent variables, only the presence ofopportunistic infections and duration on ART were significantlyassociated with hospitalization both on bi-variable andmultivariable analyses (P-value <0.05). As the duration on ARTincreased by one month, the risk of hospitalization decreased by5.4%, which is statistically significant (P < 0.001). Whereas theincidence (number) of OI’s increased by one, the risk of beinghospitalized increased by 35.2% (P = 0.002). Of the individualopportunistic infections, pneumonia was found to be the onlypredictor of hospitalization (P-value = 0.002).Conclusion: This study showed that nearly two-third of thehospitalization was within 6 months of initiation of ART; andpresence of OI and duration on ART were the only predictors ofhospitalization.