Closing Diagnostic Gaps in Pediatric HIV: Innovations in Point-of-Care and Digital Monitoring with an Asia-Pacific...

Background/Objectives: Pediatric HIV case-finding and monitoring remain constrained by delayed early infant diagnosis (EID), loss to follow-up, and limited viral load (VL) testing-challenges particularly consequential in the operationally diverse Asia-Pacific region. We systematically reviewed innovations in point-of-care (POC) and near-patient HIV diagnostics and digital monitoring relevant to children and adolescents. Methods: Following a registered protocol (INPLASY2025110058) and PRISMA 2020 guidance, we searched PubMed, EMBASE, Cochrane Library, and WHO Global Index Medicus for studies on POC/near-patient EID and VL testing, dried blood spot (DBS) workflows, and digital monitoring tools. Risk of bias was assessed using RoB 2, QUADAS-2, and MMAT. Results: Fifty-three primary studies were included (39 sub-Saharan Africa, 12 Asia-Pacific, 1 multi-country/global, 1 Americas/Caribbean). Patient selection and flow/timing were common limitations in diagnostic accuracy studies; sample representativeness and nonresponse bias were frequent concerns in implementation studies. The most consistent benefits of POC EID and near-patient VL testing were shorter turnaround times and improved cascade completion when paired with quality assurance and connectivity. Conclusions: POC diagnostics and digital monitoring can help close pediatric HIV cascade gaps, though evidence derives predominantly from sub-Saharan Africa. Impact depends on implementation design. Asia-Pacific programs should prioritize generating context-specific evidence alongside the adaptation of established lessons.