Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Early infant diagnosis of HIV: review of current and innovative practices Francesca Celletti a,b , Gayle Sherman c,d , and Ahmad H. Mazanderani c,e Purpose of review Only 51% of HIV-exposed infants receive an HIV test between 4 and 6 weeks of age, with even lower repeat testing rates at older ages, and only 49% of infants tested are initiated on antiretroviral therapy. The purpose of this article is to discuss potential solutions for increasing coverage of early infant diagnosis (EID), decreasing turnaround time for result return, improving linkages to care and treatment and fulfilling the objective of improving outcomes for HIV-infected children. Recent findings Differences in HIV testing guidelines have emerged in different countries, with some recommending HIV testing at birth. Although EID programs are not yet optimal, some solutions have proven successful including the use of short message service printers, community-based interventions and support and education of mothers. Birth and EID point-of-care testing have emerged as potential game changers for improving EID programs. Summary For EID programs to impact on child health outcomes, by preventing HIV-associated morbidity and mortality, and provide more value than a mere surveillance tool, efforts need to be aligned toward the implementation of a comprehensive set of interventions that take cognizance of different contexts, epidemiology and health systems, and that are backed by political and community support. Keywords birth testing, early infant diagnosis, pediatric HIV, point-of-care early infant diagnosis INTRODUCTION In 2015, Cuba became the first country to meet WHO validation criteria for the elimination of mother-to- child transmission [1 & ], followed by Thailand, Belarus and Armenia in the following year [2 & ]. These achievements signal great strides toward curbing the global incidence of HIV-infection among infants, with the annual number of new infections among children having reduced by 70% since 2000 [3 & ]. Nevertheless, renewed commitment will be required, particularly within high-burden settings, if more countries are to meet the set impact targets of 50 or less new pediatric HIV infections per 100000 live births and a less than 5% transmission rate in breast- feeding populations (<2% in nonbreastfeeding populations) [4 & ]. Furthermore, if early infant diag- nosis (EID) programs are to impact on child health outcomes and provide more value than merely a surveillance tool, efforts need to be focused toward timely linkage to care and initiation of antiretroviral therapy amongst those infants who test HIV-positive. Hence, questions remain regarding the optimal way and timing of HIV testing to prevent HIV-associ- ated morbidity and mortality [5 & ]. EARLY INFANT DIAGNOSIS POLICY GUIDELINES Requirements to diagnose HIV during infancy differ from standard testing methods used for adults and children aged more than 18 months due to the passive transfer of maternal antibodies. For this a Elizabeth Glaser Pediatric AIDS Foundation, Geneva 2, b Geneva School of Diplomacy, Geneva, Switzerland, c Centre for HIV & STI, National Institute for Communicable Diseases, d Department of Paedi- atrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg and e Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa Correspondence to Francesca Celletti, MD, PhD, 904 Caribbean Drive, Sunnyvale, CA 94089, USA. Tel: +1 408 541 4191; fax: +1 408 541 4192; e-mail: fcelletti@pedaids.org or francesca.celletti@gmail.com Curr Opin HIV AIDS 2017, 12:112–116 DOI:10.1097/COH.0000000000000343 www.co-hivandaids.com Volume 12  Number 2  March 2017 REVIEW