KCH is a referral hospital with a 215 bed pediatric ward located in the capital of Lilongwe with more than 10,000 pediatric admissions annually. In 2007, less than 10% of pediatric inpatients at KCH were estimated to have accessed voluntary HIV counseling and testing (VCT) services offered by lay counselors (Pediatric Department, KCH, unpublished data). In January 2008, we implemented a PITC program utilizing DBS testing in the KCH inpatient pediatric department in collaboration with the Baylor International Pediatric AIDS Initiative (BIPAI), KCH, and Lighthouse. The overall program objectives were to improve inpatient pediatric HIV diagnosis and care, establish EID as a routine inpatient service, and provide national guidance for inpatient pediatric PITC program expansion.