BACKGROUND: To scale up the Anti Retroviral Therapy (ART) program the rnGovernment of Ethiopia has recently expanded the service to include privaternhospitals. But the quality in ART service provision is hardly known particularly inrnsuch a setting. rnrnOBJECTIVES: The main objective of the study is to assess the quality of ARTrnservice in private hospitals in Addis Ababa with respect to clientsâ€™ satisfaction,rnchange in quality of life and adherence to medications. In doing so it identifiesrnunexpected problems that should be corrected immediately and it will be a goodrnprelude for future out come studies.rnrnMETHODS: A cross sectional study was conducted which used qualitative andrnquantitative approaches to look in to the inputs, process of care and outcome asrnindicators of quality of ART service being delivered in private hospitals in AddisrnAbaba. A total of 183 ART clients who were selected through cluster sampling fromrnART clinics in private hospitals in Addis were assumed for exit interview on clientrnsatisfaction, perceived quality of life and adherence to medications using adaptedrnquestionnaires. Both health care providers and ART clients were approached throughrnin-depth interview for the above indicators of service quality. Additionally check listsrnwere used to asses the structural status of ART services in these hospitals. rn rnRESULTS: A total of 183 clients accessed of which 130 of them responded (nonrnrespondent rate of 28.4%) to the questionnaire and from which 78.5% and 67.7% ofrnthem have a level above the mean satisfaction score and above the mean for quality ofrnlife respectively. Most of the clients were highly satisfied by the cleanliness andrncomfort of the environment but of the clients who were dissatisfied a significantrnnumber of them were complaining of the high cost they incur for laboratory.rnComparing the various domains for perceived quality of life the role/socialrnfunctioning and health distress were lower than the other domains. Adherence raternwas found to be 87% at 95% adherence requirement. Otherwise this study showed arnstrong relation ship between the variables client satisfaction and adherence & quality rnof life and adherence. A closer look via in-depth interview has revealed supportivernevidences for the above results and a checklist for the minimum package for ARTrnservice provision has shown no major gaps in the inputs. rnrnCONCLUSION: Clients of ART service in private hospitals are significantlyrnsatisfied with the service, have generally witnessed a better quality of life and hadrnsatisfactory adherence record. To improve these measures of quality of care furtherrnthe gaps identified should be filled by the health facilities and the major stakeholdersrninvolved. The investigator recognized the variables that contributed for the optimalrnlevel of quality of care at these hospitals and recommended a means to lowerrnlaboratory cost and provide psychosocial support along with others.