Two diagnostic alternatives that could reduce the delays complicating the current DBS systems are PD and point of care virologic testing. While PD is a less sensitive and specific diagnostic alternative to PCR, it requires limited resources and provides a strategy to immediately offer ART to hospitalized patients that fulfill PD criteria, avoiding the one-month wait time and resultant losses to follow-up. Malawi National guidelines recommend the use of PD to identify and initiate symptomatic HIV+ infants younger than 12 months of age on ART when PCR is unavailable. While the sensitivity and specificity of PD has been previously reported from Rwanda and Kenya, these studies are only partly applicable to Malawi due to the lower estimated malaria burdens in Rwandese children, and the mixture of inpatients and outpatients within the Kenyan study cohort. Both scenarios are likely to alter the reported sensitivities and specificities of PD as compared to Malawi, justifying the need to generate locally applicable data. To date, PD has not been widely practiced in Malawi, and data generated from this research could provide guidance to increase the usefulness of PD. The primary limitation to PD is that HIV-uninfected patients could be incorrectly started on ART. However, it is possible that such patients might still experience lower mortality and HIV transmission rates, with little adverse effects, as suggested by the recent outcomes of extended post-natal antiretroviral prophylaxis studies.