Introduction: Religious leaders are universally recognized as having an influence on immunization uptake and coverage in low- and middle-income countries (LMICs). Despite this, there is limited understanding of three questions: 1) how do religious leaders impact the uptake and coverage of immunization in LMICs? 2) what successful strategies exist for working with local faith actors to improve immunization acceptance? and 3) what evidence gaps exist in relation to faith engagement and immunization? Methods: In January 2021, we searched PubMed and Google Scholar databases covering the period from January 1, 2011, to January 15, 2021, with key search terms related to faith engagement and immunization in peer-reviewed literature and conducted a gray literature review to answer these three questions. We excluded articles covering faith engagement and immunization in high-income countries, news articles, online blogs, social media postings, and articles in languages outside of English. Data were coded to guide thematic analysis. Results: We found extensive evidence supporting the value of religious engagement for immunization promotion and acceptance in LMICs across faiths. However, there was limited rigorous evidence and examples of specific approaches for engaging local faith actors to strengthen immunization uptake in LMICs. As a result, there is a lack of widely shared knowledge of what works (or doesn’t) and successful models for engaging local faith actors.  Additional current evidence gaps include: few rigorous study designs; a lack of vaccine hesitancy studies outside of Nigeria and Pakistan; and limited exploration of faith engagement and immunization in religions other than Islam and Christianity. Conclusions: Our review findings reinforce the powerful role local faith actors play in diverse communities within LMICs in both promoting and inhibiting immunization uptake. The literature review comes at a critical time, given the urgent need to expand access to COVID-19 vaccination in LMICs. Findings from this review will advance understanding on how to more effectively engage local faith actors in promoting immunization campaigns and addressing vaccine hesitancy, which is more complex than expected. Further study is needed to understand how to most effectively counter vaccine hesitancy in different geographic, linguistic, and socio-cultural contexts.

There is consensus on the benefits for all infants of exclusive breastfeeding for 6 months and introduction of appropriate complementary foods at 6 months, followed by continued breastfeeding. However, guidelines on infant and young child feeding (IYCF) for HIV-positive mothers have changed continually since 2000. This article explores issues and evidence related to IYCF for the prevention and care of paediatric HIV in resource-limited settings in light of new HIV treatment guidelines, implementation challenges and knowledge gaps. In 2010 the impact of antiretroviral drugs (ARVs) on reducing the risk of mother-to-child transmission of HIV moved WHO to urge countries to endorse either avoidance of all breastfeeding or exclusive breastfeeding for the first 6 months while taking ARVs, depending on which strategy could give their infants the greatest chance of HIV-free survival. Implementation of the 2010 recommendations is challenged by lack of healthcare provider training, weak clinic–community linkages to support mother/infant pairs and lack of national monitoring and reporting on infant feeding indicators. More evidence is needed to inform prevention and treatment of malnutrition among HIV-exposed and HIV-infected children. Knowledge gaps include the effects of prolonged ARV exposure, the cause of HIV-associated growth faltering, the effects of early infant testing on continuation of breastfeeding and specific nutrition interventions needed for HIV-infected children. Significant progress has been made toward keeping mothers alive and reducing paediatric HIV infection, but sustained political, financial and scientific commitment are required to ensure meaningful interventions to eliminate postnatal transmission and meet the nutritional needs of HIV-exposed and HIV-infected children.

Accelerated efforts to end vertical HIV transmission have resulted in a 52% decrease in new infections among children since 2001. However, current approaches to prevent mother-to-child-transmission (PMTCT) assume a linearity and universality. These insufficiently guide clinicians and programmes toward interventions that comprehensively address the varying and changing needs of clients. This results in high levels of loss-to-follow-up at each step of the PMTCT cascade. Current PMTCT approaches must be adapted to respond to the different and complex realities of women, children and families affected by HIV. Drawing on the concept of an 'HIV trajectories,' we screened peer-reviewed literature for promising PMTCT approaches and selected 13 articles for qualitative review when the described intervention involved more than a biomedical approach to PMTCT and mother-child HIV treatment and care. Our qualitative analysis revealed that interventions which integrated elements of the 'HIV trajectories' perspective and built on people living with HIV support/network, community health worker, primary healthcare and early childhood development platforms were successful because they recognized that HIV is an illness, experienced, moderated and managed by numerous factors beyond biomedical interventions alone.On the basis of this review, we call for the adoption of an 'HIV trajectories' perspective that can help assess the comprehensiveness of care provided to women, children and families affected by HIV and can inform the planning and delivery of HIV and related services so that they more adequately respond to the varying needs of clients on different 'HIV trajectories'.