The prevalence of HIV infection is reported to be higher in fishing communities of Lake Victoria compared to non fishing neighboring communities. Besides, access to HIV/AIDS related services has been reported to be either inadequate or unavailable to some of these fishing communities particularly for those residing in islands. This study explored the engagement of Community Health Workers (CHWs) in provision of PMTCT services among the fishing communities of Sengerema and Musoma District Councils (DCs) in the Lake Zone of Tanzania. This was a cross sectional study using qualitative approach. Intrinsic and extrinsic motives were found to influence community members to be engaged as CHWs. The majority of CHWs were involved in Antenatal Care (ANC) and Reproductive and Child Health (RCH) as well as in health promotion activities as a strategy to cope with the shortage of trained health staff. CHWs were found to assist in HIV/AIDS Counseling and Treatment Center (CTC), generally, CHWs were not directly engaged in provision of PMTCT services. On the other hand, the National Health Policy does not clearly set roles of the CHWs and their incentives. Nevertheless, there are potentials of people willingness to volunteer in community health works that need to be better leveraged. Deploying CHWs is critical to enabling accessible primary health care services including HIV/AIDS particularly PMTCT services in remote areas such as fishing communities where human resource for health is reported to be inadequate.