In The Lancet HIV , Karl-Günter Technau and colleagues report on 12-month outcomes of 88 HIV-infected neonates. The infants were identified through birth HIV testing at a well resourced, academic, public maternity hospital in South Africa, an upper-middle-income country with an HIV prevalence of about 32%. Their infant birth HIV testing approach included testing high-risk HIV-exposed infants in era 1 (September, 2013 to May, 2014), testing all HIV-exposed infants in era 2 (June, 2014 to September, 2014), and testing all HIV-exposed infants with added point-of-care (POC) diagnostic PCR testing in era 3 (October, 2014 to June, 2016). The main outcomes were time to antiretroviral therapy (ART) initiation, mortality, retention in care, and viral suppression. Although data are from a single academic site, they provide insight into the effect of early infant HIV testing and ART initiation, which might be generalisable to similar settings. The findings are both encouraging and sobering, raising additional questions on how to optimise WHO's survive, thrive, and transform agenda for HIV-exposed children.