To close diagnostic gaps for children living with HIV, the World Health Organization (WHO) recommends routine opt-out provider-initiated testing and counselling (PITC) for inpatient wards in high-prevalence countries, which includes nucleic acid testing as part of Early Infant Diagnosis (EID) programmes for HIV-exposed infants < 18 months of age.1 There is strong evidence of the effectiveness of paediatric inpatient PITC in improving diagnosis of HIV and linkage to antiretroviral treatment (ART) in sub-Saharan Africa (SSA), including two systematic reviews of paediatric HIV testing that reported the highest positivity rates in hospitalised children.2,3 However, the implementation of routine PITC remains a challenge in the SSA hospital setting and studies have reported barriers, including insufficient staff, lack of training, stock-outs of test kits, and inadequate tools for monitoring and evaluation.4,5,6 Inpatient PITC is particularly challenging in paediatrics, as screening for breastfeeding infants requires testing their mothers, and many hospitals lack access to timely EID nucleic acid testing.1 As a result, testing coverage rates are low and many children are discharged without confirmation of HIV status.7