Unfortunately, only 239 DBS recipients, or 50.2% of children tested, enrolled into outpatient care at the Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence clinic at KCH. Of these, 48.3% were initiated on ART a median of 2.4 months after DBS collection. Low follow-up has been experienced at other EID sites throughout Malawi. One contributing factor is the several weeks of processing time required for DBS samples. In Malawi, DBS tests are transported to and from central laboratories to be processed in higher volumes by sophisticated equipment and highly specialized laboratory personnel. Therefore, counselors instruct caregivers to return in at least one month for their child's DBS test results. If caregivers return for their child's results, they are then commonly re-referred for HIV care at another site, often at an even later date, further delaying evaluation for ART eligibility. Currently, a similar system exists at KCH. Despite substantial investment into EID, the processing and transport delays inherent to DBS have lessened the impact of EID and have resulted in a continued barrier to pediatric ART access in this age group.