Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at

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... tema Hospital. Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan-Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality. A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4-8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24-4.62), STAGE IV (HR = 5.64; 95% CI: 2.53-12.56), stage III (HR = 3.31; 95% CI: 1.35-8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59-8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18-7.86), BMI ≤ 15.4 kg/m2 (HR = 2.45; 95% CI: 1.17-5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4-13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment. The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate.