Substantial percentages of HIV+ infants suffer from high mortality without early infant diagnosis (EID) and ART initiation, irrespective of CD4%, leading to the recommendation that all HIV+ children younger than 1 year of age should be universally initiated on ART. Despite the simplification of ART eligibility in this age group, diagnosing HIV remains complex. Maternal HIV antibodies can circulate in the blood stream of children until 12 months of age, confounding HIV antibody test results unable to discriminate between the mother's and child's antibodies. Accordingly, DNA PCR testing that detects HIV proviral DNA is the gold standard for HIV diagnosis in this age group. To date the PCR technology utilized in EID programs throughout sub-Saharan Africa, including Malawi, is DBS. Malawi piloted an EID program starting in 2007 and approved a policy of universal ART for all HIV+ children younger than 1 year of age in 2008. In Malawi, a uniform first line fixed-dose combination ART regimen of stavudine, lamivudine, and nevirapine is provided free of charge by the Malawian government for all eligible patients.The EID program has since expanded to 14 of 28 districts. Importantly, the national EID program identified the pediatric inpatient wards as a critical access point for routine DBS testing, but recently reported that few EID sites have established routine inpatient testing programs.