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BackgroundLimited research evidence exists on the experiences of adolescents living with HIV about their access to antiretroviral therapy during the COVID-19 pandemic in Tanzania.ObjectiveTo explore the lived experiences of adolescents living with HIV during the COVID-19 pandemic, including COVID-19-related anxiety, facilitators and barriers to accessing HIV care and treatment, and the coping strategies employed to remain healthy and resilient and if differences existed based on levels of anxiety.MethodsWe adopted a case study design to understand both normative and individual lived experiences of purposefully sampled adolescents receiving HIV care during the COVID-19 pandemic with higher and lower anxiety levels. A total of 32 participants took part in the study, including 24 in focus group discussions and 8 in in-depth interviews. Data were analyzed using thematic analysis.ResultsAdolescents living with HIV faced heightened anxiety and notable barriers to accessing HIV services during the COVID-19 pandemic. Their anxiety was driven by fear of infection, uncertainty about prevention measures, concerns about receiving care outside HIV clinics, and a perceived increased vulnerability. Many reported difficulty attending clinic appointments, largely due to government- and parent-imposed restrictions such as stay-at-home directives, mandatory mask use, and limited public transport capacity, but no difference based on anxiety level.To cope, adolescents relied on treatment adherence knowledge, self-efficacy, and family support. Both low- and high-anxiety groups encountered similar barriers to care and treatment adherence; however, those with higher anxiety reported greater fear of infection, less confidence in coping, and less helpful coping skills. No differences were observed by sex or age.ConclusionThe findings highlight that self-efficacy, risk-reduction knowledge, problem-solving skills, and family support helped reduce anxiety and support treatment adherence among adolescents living with HIV, underscoring the need for targeted support programs during public health crises.