Better quality of services is essential for the sustainability of HIV programs, in particular in rural Sub-Saharan Africa, to support the increasing number of individuals treated with combination antiretroviral therapy (cART). However, longitudinal data from rural care and treatment centers (CTC) are scarce. The objective was to assess trend in quality of care for HIV infected persons before start of combination antiretroviral therapy (pre-ART). A retrospective analysis of pre-ART registers and patient's files of 1950 patients enrolled in the Bagamoyo CTC in Tanzania between 2008 and 2010 analyzing was conducted; with parameters including year of enrollment, gender, age, CD4 cell count and WHO clinical stage at time enrollment. We noted a significant increase by 20% of total patients who had CD4 cell count performed from 69% (n=457) in 2008, 83% (n=493) 2009 to 89% (n=616) 2010 (X²= 87.014, P<0.0001). Patients who presented with advanced HIV disease, i.e. WHO clinical stage 4 decreased by five percent from 2008 to 2010; i.e. from 13% (n=87) to 7% (n=45) (X²= 14.945, P<0.0001). Vice versa, significantly increased from 16% (n=103), 19% (n=113) to 37% (n=255) presenting early i.e. WHO stage 1, in 2010, 2009 to 2008 (X²= 85.028, P<0.0001) was noted respectively. These findings indicate that services offered to HIV infected persons pre-ART has progressively improved at the Bagamoyo Care and Treatment Center between 2008 and 2010. Yet still about one third of patients arrive with CD4 cell count below 200cells/mm³. Efforts must be undertaken for more HIV testing and timely referral of HIV-infected patients to CTC.