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Nuwagaba-Biribonwoha et al. BMC Pediatrics 2010, 10:44 /1471-2431/10/44 R E S E A R C H A R T I C L E Open Access Research article Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania 1 1,5 1,6 1,7 1 Harriet Nuwagaba-Biribonwoha* , Bazghina Werq-Semo , Aziz Abdallah , Amy Cunningham , John G Gamaliel , 1 2 3 2 4 2 Sevestine Mtunga , Victoria Nankabirwa , Isaya Malisa , Luis F Gonzalez , Charles Massambu , Denis Nash , 2 2 Jessica Justman and Elaine J Abrams Abstract Background: In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation. Methods: In September 2006, a molecular biology laboratory at Bugando Medical Center was established in order to perform HIV DNA PCR testing using Dried Blood Spots (DBS). Ninety- six health workers from 4 health facilities were trained in the identification and care of HIV-exposed infants, HIV testing algorithms and collection of DBS samples. Paper-based tracking systems for monitoring the program that