Globally, an estimated 2.2 million children younger than 15 years of age were HIV-infected in 2007, with approximately 90% living in sub-Saharan Africa. Malawi, a sub-Saharan African country of 13.2 million people, reports an adult HIV prevalence of 11.9%. While 91,000 HIV+ children were estimated to be living in Malawi in 2007, less than 8% of all Malawian children have ever been HIV tested. Additionally, HIV+ children comprised just 8% of all national ART recipients, well below the 2014 goal of 15%. To address this gap, Malawi approved the routine offering of HIV testing, or provider initiated HIV testing and counseling (PITC), in line with global recommendations in 2007. While there is a high HIV prevalence in hospitalized Malawian children and current guidelines support routine inpatient HIV testing, no clear implementation strategy for hospitals has been offered.