In collaboration with DOT/IO Health, this project connected macro-level data with lived human experiences. Our work was built directly on the quantitative foundation of DOT/IO Health’s Phase 1 geospatial mapping initiative, which analyzed disease prevalence across Europe and identified Poland as a highly impacted region. By layering qualitative, human-centred insights onto this epidemiological data, our team integrated the human perspective— translating demographic and disease-state data into a person-centred care pathway for forced Ukrainian migrants.

The full-scale invasion of Ukraine began on February 24, 2022, sparking the largest and fastest-growing forced migration crisis in Europe since World War II. With Ukraine having the second-largest population of people living with BBVs in Europe, ensuring that displaced migrants continue to receive care emerged as a new and critical challenge. 

To address this, our client—a world leader in BBV therapies—focused efforts on Kraków, Poland, a city strategically chosen for its large influx of displaced Ukrainian migrants and its existing healthcare infrastructure needed to support BBV care. There, they aimed to understand how to improve screening and linkages to care during a global crisis and within a unique, evolving context.

The project aimed to build on geo-mapping, demographic, and disease-state data by pairing:

• Quantitative data capturing the prevalence and geographic distribution of Ukrainians living with HIV, HBV, and HCV, and
• Qualitative insights from Polish citizens, healthcare providers, support workers, and Ukrainian forced migrants.

Enhancing BBV care through human-centred design

Drawing on a variety of qualitative methodologies and tools rooted in human-centred design and service design, we took a 3-phase approach:

1. Mapping the current state
2. Engaging experts and Ukrainian forced migrants
3. Equipping field teams

Phase 1: Mapping the current state

It was essential that our research approach include a deep dive into the political climate, migration patterns, demographics, and BBV prevalence data across Poland and Ukraine. To achieve this, we:

• Reviewed extensive existing literature and conducted a thorough review of prior geo-mapping data.
• Conducted in-depth interviews with 5 expert members of the client team to gain a deeper understanding of:
  • The current barriers and enablers of entering and exiting the care pathway in Krakow, and in Poland more generally.
  • Polish policy and system reform/changes to address migration patterns.

With this comprehensive understanding, we created a care pathway map to illustrate the complex experience of being forced to flee due to war while living with a chronic disease. The map highlights two different migration experiences: one of a person diagnosed with a BBV in Ukraine and another of a person diagnosed in Poland.

Phase 2: Engaging experts and Ukrainian forced migrants

To build trust and connect with Ukrainians living with BBVs, we began by virtually engaging with infectious disease specialists and support workers in Poland. Through these connections, we were introduced to Ukrainians who provide navigation and emotional support to people living with HIV and Hepatitis in Poland. This network also facilitated introductions to Ukrainians living with BBVs, allowing us to hear their personal stories about fleeing due to the war, their emotional experiences after receiving a BBV diagnosis, the process of accessing treatment in Ukraine and Poland, and the struggles and successes of living with a BBV.

To synthesize and validate our hypotheses from Phase 1, we conducted 60-minute interviews with:

• Ukrainian migrants who had interacted with the Ukrainian and Polish healthcare systems, and
• On-the-ground experts who could offer a population-wide perspective on barriers and enablers to accessing care in Poland.

Sensitive interview considerations played a key role in planning and carrying out these engagements, which involved establishing genuine connections that allowed us to meet members of a vulnerable community and listen to their personal stories. 

To achieve this safely and respectfully, we leaned on cultural adaptation methodologies to ensure that initial versions of our key communication documents, which utilized translation support from large language models, accounted for cultural nuances. These were reviewed by native Ukrainian and Russian speakers to ensure accuracy.

Phase 3: Equipping field teams

Our learnings from these engagements were synthesized into an adaptable deliverable that balanced the unique Ukrainian experience with the broader forced migrant experience.

The final deliverable package included:

• A Ukrainian migrant care pathway map
• A care pathway map template for other migrant communities
• Insights on key challenges to BBV care
• Guiding principles for improving access to BBV care
• A strategic opportunities report

Delivering a scalable model for enhancing migrant BBV care

To support future initiatives, we created a scalable care pathway template and adaptation guide, including instructions for adapting the care pathway for other migrant populations with, or at risk of, BBVs across various countries and settings. 

Our literature review, migrant interviews, and expert engagements informed the development of four guiding principles. These principles served as a foundation to help our client focus on key opportunity areas in a way that would most equitably and effectively improve access and care for Ukrainians living with, or at risk of, BBVs in Poland. 

While developed from the perspective of Ukrainians in Poland, these principles offer a scalable model to enhance access and care across various migrant populations living with, or at risk of, BBVs.

The final deliverables equipped our client with a deep, empathetic understanding of the Ukrainian migrant experience. By using both qualitative and quantitative insights, our client has partnered with a large university hospital in Poland to introduce new testing processes in their emergency room. 

These changes have the potential to affect all patients who visit the emergency room and to improve regional screening, diagnosis and treatment of BBVs. Our client is currently adapting these deliverables for other migrant populations.