Background: -Treatment of malnutrition is essential in addition to antiretroviral treatment for clients who are malnourished. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program but HIV clients receiving the therapeutic food package, still sufer with low recovery. Although the factors contributing to the low recovery were reported, some crucial factors such as viral load status, disclosure status,distance to health institutions, differentiated service delivery and comorbidity with chronic illness were overlooked in earlier investigations. Objective: - To assess the nutritional recovery and associated factors among adult HIVclients on therapeutic feeding program at South Achefer health facilities North West Ethiopia, 2022. Methods: -An institution-based cross-sectional study was conducted from May 25 to June 22, 2022 among adult HIV clients on ready to use therapeutic food enrolled from February 2011- January 2021.The data were gathered from 411 patient records, which was chosen using a simple random sampling method to select the record of each patient from the therapeutic feeding registration logbook from each clinics based on their unique identification number, and then their charts were reviewed. Binary logistic regression analysis were done for independent variables with an outcome variable. Variables with significant associations for nutritional recovery of ready to use food therapywas identified based on AOR with a 95% CI and p-value < 0.05. Results: - In this study, the recovery was 46.5%(95%CI:(41.8-51.1). Baseline nutritional status at enrollment SAM (AOR=2.20 (95% CI,(1.368-3.577), not envolved differential service delivery (AOR =0.551 (95% CI,(0.310-0.982) and poor adherence to ART (AOR=2.31 (95% CI,(1.441-8.455) were predictors of recovery rate in adult HIV patients enrolled in the food by prescription program. Conclusion and Recommendation:- The recovery of this study was low when compared to the sphere standard. Severity of malnutrition, clients involved in differentiated service delivery and poor adherence to ART were the predictors of low recovery rate. Enhance quality of life and minimize nutritional impact by promptly treating infections and managing symptoms that affect nutrient intake and it is also preferable to modify the monthly appointments for prescribing ARV drugs for malnuritioed clients.