ABSTRACT Back ground: Ensuring good adherence is critical to the success of highly active anti-retroviralrntherapy (HAART). Failure to adhere very closely to the regimens results in continued viralrnreplication, treatment failure and the emergence of drug resistant strains of human immunerndeficiency virus (HIV). Although parents and caregivers may have primary responsibility forrntheir childrenÂ©s medication-taking, there is no single study that examined parents influence onrnpediatrics highly active anti-retroviral therapy (HAART) adherence in our set up. The result ofrnthe study is expected to help device intervention strategies to improving childrenâ€™s adherence onrnhighly active anti-retroviral therapy (HAART). rnObjectives: To assess the status, determinants of adherence and identify parental factorsrninfluencing pediatrics highly active anti retroviral therapy (HAART) adherence in Addis Ababa. Methods: An observational: descriptive, cross sectional study was conducted in 9 Healthrninstitutions: public, private and Non Governmental Organizations (NGOs) in Addis Ababa.rnMulti-stage sampling procedure was used to select a total of 586 children: age 0 - 14 years,rnHuman Immune Deficiency Virus (HIV) infected and started anti-retroviral therapy (ART) 12rnweeks ago. Primary care givers of the children were enrolled after the nature of the study wasrnexplained that allowed informed decision to be made and written consent obtained. Data wasrncollected from February 8- May 10, 2010 on socio demographic, parent factors, clinical markers,rncare givers to provider relationship and regimen variables. Structured questionnaire and focusrngroup discussion were used. Univariate, bivariate and multivariate analysis was carried out. Result: The parental factors were strongly associated with non adherence; children who had nonrnbiological parents [OR=9.805(95%CI= 2.198, 43.736)], parents who didnâ€™t communicate about rnHIV and ART adherence to their children [OR=3.915 (95%CI= 1.273, 12.036)], and parents whornhadnâ€™t good relationship with health care providers [OR=29.592(95%CI= 1.326, 660.333)] werernmore likely non adherent. Children who had more than four siblings [OR= 5.676 (95%rnCI=2.100, 15.339)] were also significantly associated with non adherencernConclusion: The parental factors were strongly associated with non adherence. The need forrnproviders to have smooth relation ship with the care givers of the HIV infected children onrnantiretroviral therapy, support caregivers to communicate with their children about the diseasernand antiretroviral therapy adherence is critical. Further research is recommended to explore thernvalidation of self report adherence using longitudinal study designs.