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Background: Consistent condom use plays a significant role in the successful protection of the transmission of human immunodeficiency virus (HIV) infection in couples with sero-discordant HIV status, mother-to-child-transmission (MTCT), and acquiring other strains in HIV-positive concordant pairs. Limited data and information about this issue are available in low-resource setting countries, including the study setting. Therefore, this study aimed to assess the level of consistent condom use and its associated factors among HIV-positive pregnant women., Materials and Methods: An institution-based cross-sectional study was done from 17 October 2020 to 1 March 2021. A total of 423 HIV-positive pregnant women were involved in this study and selected using a systematic random sampling technique. Data were collected using a semi-structured, pretested, and interviewer-administered questionnaire and then entered into EPI INFO version 7 and analyzed using Statistical Package for Social Sciences (SPSS) version 21. Logistic regressions were performed to identify factors. P -Value ≤ 0.05 denotes statistical significance., Results: The prevalence of consistent condom use among HIV-positive pregnant women was 14.2% [95% confidence interval (CI) 10.9%, 17.5%]. Women having a higher educational status [adjusted odds ratio (AOR) = 6.33, 95% CI 1.96, 20.42], women having a CD4 count > 600 cells/mm (AOR = 4.78, 95% CI 2.08, 10.97), women testing positive for HIV during the non-pregnant state (AOR = 5.99, 95% CI 3.01, 11.94), and women disclosing their HIV status to sexual partners (AOR = 4.85, 95% CI 1.71, 13.71) were found to be statically significant with women's consistent condom use., Conclusion: In this study, consistent condom use among HIV-positive pregnant women was low. Women having educational status of college and above studies, women testing positive for HIV during the non-pregnant state, women disclosing their HIV status to a sexual partner, and women having a CD4 count > 600 cells/mm had better consistent condom use. Hence, giving more emphasis on health education and counseling service about HIV testing before pregnancy, and disclosing their HIV status to their sexual partners and about the need for consistent condom use during pregnancy would be important., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tibebu, Kassie, Kebede, Anteneh, Temesgan, Aklil, Wondie, Abegaz, Ayalew and Rade.)