Tuberculosis (TB) caused by Mycobacterium tuberculosis (M.tuberculosis) bacteria is a serious public health threat, especially for people living with Human immunodeficiency virus (HIV) /Acquired Immunodeficiency Syndrome (AIDS). Worldwide, TB is one of the leading causes of death among people living with HIV/AIDS. Health institute based cross-sectional study was conducted from November 2022- April 2023 to determine the prevalence and associated factors of TB among HIV/ AIDS patients attending health facilities in south Achefer district, northwest Ethiopia. A total of 270 HIV sero-positive patients were included and fresh sputum samples were collected by laboratory technologists and Ziehl–Neelsen (ZN) staining microscopy tests were conducted to detect the TB statuses of HIV/AIDS patients. Relevant data were also collected using structured questionnaire and from patients‟ history cards at HIV clinic. Data were analyzed using SPSS version 25. Data were analysis by descriptive statistics used to describe the findings and multivariate logistic regression was performed to identify factors independently associated with TB infection. In the present study, out of 270 HIV sero positive patients, 64 (23.7%) were found to have pulmonary tuberculosis. Female HIV/AIDS cases (AOR: 10.5, 95% CI:1.68- 8.27, p=0.014), patients in age ≥36 (AOR: 3.01, 95% CI : 0.02-32.52, p=0.03),WHO clinical stage IV (AOR:2.04,95% CI:1.04-3.99,p=0.023), alcoholic drinks (AOR 1.9, 95% CI( 4.14-88.36)) ,and smoke cigarette (AOR: 5.36, 95% CI (1.07–5.19)) were more likely to develop TB as compared to their counterparts. The prevalence and associated risk factors of TB among HIV/AIDS patients at Durbete health facilities was quite high. The co-infection was associated with female HIV/AIDS cases, age 36 and above, WHO clinical stage IV, consume alcoholic drinks, and smoke cigarette. Thus, health facilities in the district should HIV/AIDS cases emphasizing on the modes of transmission of TB and potential risk factors (alcohol consumption and cigarette smoking), which may increase the likelihood of TB infection. Keywords: Adult HIV/AIDS patients, Prevalence of TB, risk factors, Tuberculosis