We explored women’s experiences of Option B+ in sub-Saharan Africanhealth facility settings through a meta-ethnography of 32 qualitativestudies published between 2010 and 2019. First and second-orderconstructs were identified from the data and authors’interpretationsrespectively. Using a health systems lens, third-order constructsexplored how the health systems shaped women’s experiences ofOption B+ and their subsequent engagement in care. Women’sexperiences of Option B+ services were influenced by their interactionswith health workers, which were often reported to be inadequate andrushed, reflecting insufficient staffing or training to address pregnantwomen’s needs. Women’s experiences were also undermined by variousmanifestations of stigma which persisted in the absence of resourcesfor social or mental health support, and were exacerbated by spaceconstraints in health facilities that infringed on patient confidentiality.Sub-optimal service accessibility, drug stock-outs and inadequatetracing systems also shaped women’s experiences of care.Strengthening health systems by improving health worker capacity toprovide respectful and high-quality clinical and support services,improving supply chains and improving the privacy of consultationspaces would improve women’s experiences of Option B+ services,thereby contributing to improved care retention. These lessons shouldbe considered as universal test and treat programmes expand.