Aims Provider initiated testing and counselling (PITC) is recommended for all inpatients in Malawi if they have not been tested in the previous 3 months. However testing rates remain low. We sought to determine if a bedside diagnostic HIV testing service would improve testing rates amongst paediatric inpatients.

Methods We audited the existing HIV testing service to determine the numbers of children being tested for HIV. This was followed by the introduction of a bedside diagnostic service followed by re-audit. Bedside testing was facilitated by health systems strengthening measures including identification of motivated counsellors, appropriate supervision and remuneration.

Results In the initial audit in March–April 2014, 81 (60%) of 135 children had documented HIV tests, with 54 (40%) having no documented test. Following implementation of the bedside diagnostic HIV testing service, there was a significant increase in the proportion of children whose HIV status was known. On re-audit in July 2015, 110 (94.8%) of 116 children had documented HIV tests, with 6 (5.2%) having no documented test. [‘known HIV status’ of inpatients X² (2, N=251) = 41.60, p < 0.001]. Of those with documented tests, 94.5% were tested within the 3-month standard, compared to 67% initially. Following the introduction of the service, the proportion of children tested for HIV during admission increased from 31.8% to 68.1% [X² (2, N=251) = 48.57, p < 0.001].

Conclusion A bedside diagnostic HIV testing service lead to considerably improved HIV testing rates among paediatric inpatients compared to a non-bedside service. It is yet to be seen if this will lead to more children receiving HIV treatment.