The objective of the study was to assess the operational integration of maternal HIV testing and syphilis screening in Mwanza, Tanzania. Interviews were conducted with 76 health workers (HW) from three antenatal clinics (ANC) and three maternity wards in 2008–2009 and 1137 consecutive women admitted for delivery. Nine ANC health education sessions and client flow observations were observed. Results: Only 25.0% of HWs reported they had received training in both prevention of mother-to-child transmission (PMTCT) and syphilis screening.