The Tanzania HIV Care and Treatment Plan was launched in October 2004 aiming at providing 440,000 AIDS patients with antiretroviral drugs (ARVs) and track disease progression in 1.2 million HIV+ persons by the end of the 2008. This paper is intended to provide information to stake holders of the achievements and challenges of the HIV Care and Treatment Plan since its inception in 2004. Facility patient reports are aggregated at district and then regional level before being sent to the national level where they are aggregated to form a national report. By December 2007, 210 health facilities were offering HIV care and treatment services in Tanzania. About 123,147 (5 %) of the 2,636,785 estimated people living with HIV and AIDS were enrolled, and 71,439 (13.6 %) of the estimated 527,357 AIDS cases commenced ART. More females than males started ART, F: M ratio being 3: 2. Most (49 %) patients were started ART due to low CD4 counts (<200). About 6,618 patients had their initial ARV regimen changed due to starting anti-TB treatment 679 (10 %), peripheral neuropathy 812 (12%), skin rash 378 (6 %), and stock out 247 (4 %) or other reasons (18 %), while 2,653 (42 %) had no reason recorded. The proportion of patients still alive and on ART at 6, 12 and 24 months after initiation of treatment was 60 %, 60 % and 50 %, respectively, while those collecting ARVs on schedule was 34 %, 25 % and 10 % respectively. About 3,084 patients developed TB after starting ART, of whom 1,557 (~50%) patients during the first three months of treatment. During the three years (2004-2007) of HIV care and treatment services in Tanzania, there has been an increase in the number of CTC facilities, geographical coverage of services, the number of enrolled patients and those on ART. However, the set target for ART services has not been achieved and there are significant geographical variations in these achievements, which do not correspond with either population density or disease burden. Efforts should be made to i) ensure equitable accessibility when scaling up ART services in Tanzania, ii) improve the recording and reporting system, and iii) harmonize the activities of various stakeholders.