Tanzania is among of the countries which have made inspiring success on achieving the UNAIDS 95–95–95 targets. Despite considerable progress, ownership of the implemented HIV programs at regional and council level is critical for efficient coordination of resources, optimized return on investment and long-term sustainability. However, the concept of local ownership has evolved over time where involvement of the local leadership at regional and council level in planning, coordinating managing, and delivery of HIV programs has not been done adequately and risk the long-term sustainability of such programs. To address that gap, the engagement and enhancement of the capacities of the local leadership at regional and council level is inevitable to allow them to better manage the complexity of implemented HIV programs within the primary healthcare systems while sustaining the sector-wide gains.