Barr BAT, et al. - In view of the routine data from Malawi's prevention of mother-to-child transmission (MTCT) option B+ programme suggesting high uptake of antiretroviral therapy (ART) among pregnant women, researchers sought to present the early transmission data for infants aged 4–12 weeks recruiting a nationally representative sample of HIV-exposed infants and their mothers in Malawi using a multistage cluster design. They performed HIV screening in all mothers attending an under-5 vaccination or outpatient sick-child clinic with infants aged 4–26 weeks at 54 health facilities selected across ten districts and four regional sampling zones, between October 16, 2014, and May 17, 2016. In total, 3542 (10·4%) of 33,980 mother (guardian)–infant pairs had confirmed HIV exposure, with infants aged 4–26 weeks. The MTCT rate was 3·7% overall and ranged from 1·4% in women who initiated ART before pregnancy to 19·9% in women not on ART. Mothers reported reception of infant nevirapine prophylaxis in 98·0% among HIV-exposed infants, and there were only 45·6% who were already enrolled in an exposed infant HIV care clinic at the time of study screening. Data here suggest higher ART coverage and lower early MTCT as a consequence of Malawi's decentralization of ART services. However, continuous suboptimal uptake of services was noted for HIV-exposed infants.