Background Adherence to antiretroviral treatment (ART) among HIV-positive pregnant and breastfeeding women is influenced by various context-specific factor. This study aimed to investigate clinic experience and adherence among pregnant and breastfeeding women living with HIV. This cross-sectional study was conducted among pregnant and breastfeeding women living with HIV who were receiving care at selected health facilities in Kilimanjaro region.

Methods Data were collected through face-to-face interviews using a semi-structured questionnaire. We analyzed data using descriptive statistics to describe levels of adherence. Differences in adherence rates between pregnant and breastfeeding women were assessed using chi-square tests.

Results The study included 100 breastfeeding women and 42 pregnant women. Self-reported adherence to antiretroviral therapy (ART) among pregnant and breastfeeding women was 94%, while pharmacy refill data indicated adherence rates of 57%. Although not statistically significant, pregnant women were found to be more adherent compared to breastfeeding women by 57.14%, (p = 0.987). Women who were satisfied with clinic care also tended to be more adherent, with a rate of 57.45%, (p = 0.248), compared to those who were not satisfied. Fifteen percent of the participants reported having to travel a long distance to access the clinic, despite other facilities nearby. This was attributed to concerns about stigma, lack of comfort, and unfriendly healthcare workers. Eighty percent of the women understood the importance of adhering to ART. However, only 37% had attended workshops or training sessions at the clinic on adherence to ART and medications.

Conclusion This study highlights the importance of ensuring access to healthcare services for pregnant and breastfeeding women living with HIV. Despite the high level of understanding of the importance of adherence to ART, only few women had attended workshops or training sessions on adherence to ART. Efforts should be made to increase participation in training and education programs to improve adherence to ART.