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

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.