Limits to evidence-based health policymaking: Policy hurdles to structural HIV prevention in Tanzania

► In Tanzania, decision processes concerning HIV prevention radically differ from rationalistic models of resource allocation. ► Preventive measures' political attractiveness depends on their visibility and expected time frame of political returns. ► Vertical disease control and fragmented donor support are externality-prone and hamper structural prevention approaches. ► Policy-packaging can help overcome policymakers' perception of structural prevention as being boundless and overly complex. ► Decision tools meant to optimize health outcomes might have limited effects in real-world prioritization processes.