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Seifadin Ahmed Shallo,1 Mesfin Tassew2 1Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia; 2Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, EthiopiaCorrespondence: Seifadin Ahmed ShalloDepartment of Public Health, College of Medicine and Health Sciences, Ambo University, P.o.box-19, Ambo, EthiopiaTel +251 910768226Email seifadinahmed8226@gmail.comBackground: Evidence from previous studies supports the idea that informing children about their HIV status has long-term positive implications in HIV disease management, children’s quality of life, and ART drug adherence. However, in sub-Saharan African Countries, the HIV status disclosure among children ranges from 0% to 69.2%. So it is important to investigate the up to date evidence that will help in designing contextualized approaches for disclosure. Therefore, this study aimed to assess the HIV status disclosure and its associated factors among children on ART in West Shoa Zone, Ethiopia.Materials and Methods: Institutional-based observational study was conducted from February to April 2019. Quantitative data were collected from a randomly selected sample of 247 HIV positive children on ART for the last six months, and the qualitative data were collected from caregivers and health care professionals.Results: The mean age of the children was 11.11±SD2.8, and 43.6%, (95% CI: 37, 50.9) of the children were fully disclosed. The average age at disclosure was 11±SD2.12. The main reasons for the disclosure were for drug adherence and better self-care while being underage was the commonest reason for non-disclosure. Compared to the age 10– 15 years, the child in the age 6– 9 was 97% [AOR: 0.027, 95% CI: 0.003, 0.22, P< 0.001] less likely to be disclosed. Female children were 2.7 times more likely to be disclosed compared with male children [AOR: 2.73, 95% CI: 1.24, 6, P< 0.013].Conclusion: This finding reveals that HIV status disclosure is generally low, and the decision to disclose or not is affected by factors like child-related, caregivers, and health institution-related factors. This may affect the child’s drug adherence, treatment outcome, and disease transmission. Updating health care providers’ knowledge and skills and working on caregivers’ attitude are needed to manage disclosure and challenges following it.Keywords: disclosure, children, West Shoa