Impact of Surge 2.0 intervention to enhance pediatric HIV cascades outcomes in Nairobi and Kajiado Counties, Kenya: A Quasi-Experimental Study

Impact of Surge 2.0 intervention to enhance pediatric HIV cascades outcomes in Nairobi and Kajiado Counties, Kenya: A Quasi-Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Surge 2.0 intervention to enhance pediatric HIV cascades outcomes in Nairobi and Kajiado Counties, Kenya: A Quasi-Experimental Study Susan Arodi, Ashford Munene, Gilbert Ruttoh, Elizabeth Kubo, Collins Odhiambo, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8906669/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Despite global progress in HIV treatment, pediatric coverage continues to lag behind adult populations. The USAID Fahari ya Jamii project implemented Surge 2.0, a targeted, data-driven intervention to enhance pediatric HIV cascade outcomes in Nairobi and Kajiado Counties, Kenya. This study assessed the impact of the intervention and compared outcomes between the two counties. Methods We conducted a quasi-experimental study employed a pre-post study across 50 high-volume health facilities (29 in Nairobi, 21 in Kajiado). The six-week intervention (January-June 2022) included case management, joint caregiver-child appointments, optimized ART regimens, and real-time monitoring using electronic medical records and dashboards. Outcomes included HIV positivity, ART initiation, and viral load suppression. Paired t-tests were used to assess differences pre- and post-intervention. Results A total of 2,839 children were tested. HIV positivity increased from 1.56% (24/1540) pre-intervention to 2.85% (37/1299) post-intervention (p = 0.017). The highest positivity rate was among children aged 1–4 years at 3.34% (12/359). Index testing had highest yield of 3.36% (23/684). Kajiado recorded higher positivity at 4.78% (16/335) compared to Nairobi at 2.18% (21/964). Same-day ART initiation improved from 47.8% (11/23) to 61.3% (19/31). Viral suppression improved from 89.8% (608/677) to 91.1% (680/747), with significant improvement observed in Kajiado County (p = 0.0302). Conclusion Surge 2.0 improved pediatric HIV case identification, ART initiation, and viral suppression particularly in rural settings. Data driven, multi-strategy approaches are effective in strengthening pediatric HIV programs and should be scaled up. Pediatric HIV Surge intervention index testing vital suppression Kenya HIV cascade Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 Apr, 2026 Reviews received at journal 03 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 24 Mar, 2026 Editor assigned by journal 23 Mar, 2026 Editor invited by journal 27 Feb, 2026 Submission checks completed at journal 27 Feb, 2026 First submitted to journal 27 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8906669","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611536416,"identity":"3a28d5a6-4ca3-46c8-aca6-f0d9bf0df0fe","order_by":0,"name":"Susan Arodi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYLACHgMbfgaGAyDmAR4QydhAWEuaZAOJWhgOS0IVgfXh1yLffvbhgzcF5yUMDh5gk/i4444MA/vhB4wzKnBrMTiTbmw4x+C2hMGBA2ySM88842HgSTNg3HAGjxaGNDZpHoPbdSAt0rxth4F+yWFgfNiGx2H9z0BazkkgtPC/AWr5h8czN8C2HEDSIgG0ZSMe/xvceMYM9EuyhOSBg82WM9ue8bBJPDM4OOMYPoelMT5488dOgu/G4YM3PrbdsefnT374sKcGj8NgQOHGQYhj2BhgsUMIyPfjcf4oGAWjYBSMbAAAAdRTKSg9IO8AAAAASUVORK5CYII=","orcid":"","institution":"University of Nairobi","correspondingAuthor":true,"prefix":"","firstName":"Susan","middleName":"","lastName":"Arodi","suffix":""},{"id":611536417,"identity":"928c00a5-69fa-4c99-94be-8284ae1cacb4","order_by":1,"name":"Ashford Munene","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Ashford","middleName":"","lastName":"Munene","suffix":""},{"id":611536418,"identity":"db86cad1-f260-4553-a2ff-8365c46a7492","order_by":2,"name":"Gilbert Ruttoh","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Gilbert","middleName":"","lastName":"Ruttoh","suffix":""},{"id":611536419,"identity":"27d4bb57-b0c0-4dcd-8bc4-c260a7fd0f72","order_by":3,"name":"Elizabeth Kubo","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Kubo","suffix":""},{"id":611536420,"identity":"9af6a203-8c24-4d24-9335-5b518ef71ef6","order_by":4,"name":"Collins Odhiambo","email":"","orcid":"","institution":"University of Illinois","correspondingAuthor":false,"prefix":"","firstName":"Collins","middleName":"","lastName":"Odhiambo","suffix":""},{"id":611536421,"identity":"08b9551a-6d10-480f-b57f-c7f439cc9d4e","order_by":5,"name":"Reson Marima","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Reson","middleName":"","lastName":"Marima","suffix":""},{"id":611536422,"identity":"c2107801-9b48-49be-9cfd-7adad1ef0d98","order_by":6,"name":"Teresa Simiyu","email":"","orcid":"","institution":"United States Agency for International Development","correspondingAuthor":false,"prefix":"","firstName":"Teresa","middleName":"","lastName":"Simiyu","suffix":""},{"id":611536423,"identity":"c0f6939d-b668-4065-a2c1-1b133e2dd9c6","order_by":7,"name":"Isabella Yonga","email":"","orcid":"","institution":"United States Agency for International Development","correspondingAuthor":false,"prefix":"","firstName":"Isabella","middleName":"","lastName":"Yonga","suffix":""},{"id":611536425,"identity":"97e466ad-377c-4e16-bc3b-0169eaf791b8","order_by":8,"name":"Jared Mecha","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Jared","middleName":"","lastName":"Mecha","suffix":""},{"id":611536428,"identity":"b39836f1-9c25-48c8-9a92-8163780d414b","order_by":9,"name":"C. 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The USAID Fahari ya Jamii project implemented Surge 2.0, a targeted, data-driven intervention to enhance pediatric HIV cascade outcomes in Nairobi and Kajiado Counties, Kenya. This study assessed the impact of the intervention and compared outcomes between the two counties.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a quasi-experimental study employed a pre-post study across 50 high-volume health facilities (29 in Nairobi, 21 in Kajiado). The six-week intervention (January-June 2022) included case management, joint caregiver-child appointments, optimized ART regimens, and real-time monitoring using electronic medical records and dashboards. Outcomes included HIV positivity, ART initiation, and viral load suppression. Paired t-tests were used to assess differences pre- and post-intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 2,839 children were tested. HIV positivity increased from 1.56% (24/1540) pre-intervention to 2.85% (37/1299) post-intervention (p\u0026thinsp;=\u0026thinsp;0.017). The highest positivity rate was among children aged 1\u0026ndash;4 years at 3.34% (12/359). Index testing had highest yield of 3.36% (23/684). Kajiado recorded higher positivity at 4.78% (16/335) compared to Nairobi at 2.18% (21/964). Same-day ART initiation improved from 47.8% (11/23) to 61.3% (19/31). Viral suppression improved from 89.8% (608/677) to 91.1% (680/747), with significant improvement observed in Kajiado County (p\u0026thinsp;=\u0026thinsp;0.0302).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSurge 2.0 improved pediatric HIV case identification, ART initiation, and viral suppression particularly in rural settings. Data driven, multi-strategy approaches are effective in strengthening pediatric HIV programs and should be scaled up.\u003c/p\u003e","manuscriptTitle":"Impact of Surge 2.0 intervention to enhance pediatric HIV cascades outcomes in Nairobi and Kajiado Counties, Kenya: A Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 19:04:48","doi":"10.21203/rs.3.rs-8906669/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"125912886869810088465109464479845256323","date":"2026-04-05T18:39:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T17:39:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243318509874912960969235936245299102695","date":"2026-04-02T19:53:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88138498894707468711394454537061547325","date":"2026-04-01T09:49:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329521987659067288965990727609874847174","date":"2026-03-24T17:03:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-24T16:22:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T12:42:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-27T16:32:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-27T15:40:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-27T09:36:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89226105-df85-43fd-a15c-c20277abaf94","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T19:04:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 19:04:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8906669","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8906669","identity":"rs-8906669","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}