In coordination with the national EID program in 2008, we implemented a routine HIV testing strategy within the pediatric inpatient ward at Kamuzu Central Hospital (KCH) that incorporated DBS. While our initial program results have been encouraging, we have observed that only 50.2% of DBS recipients have returned for their test results after hospital discharge, draining resources and reducing the potential impact of definitive virologic testing and early diagnosis. DBS technology is a contributing factor to low patient follow-up as it requires burdensome transport and lengthy processing by highly trained laboratory personnel, requiring patients to return several weeks after testing for their results. Currently in Malawi, as is the case throughout sub-Saharan Africa, definitive virologic testing that provides test results prior to hospital discharge is not routinely available.